TOPLINE:

The implementation of a modified Skin and Ultraviolet Neoplasia Transplant Risk Assessment Calculator (SUNTRAC) risk-based surveillance program, which included primary care, dermatology, and transplant specialties, increased screening rates and early detection of skin cancer in high- and very high-risk solid organ transplant (SOT) recipients, without raising healthcare utilization.

METHODOLOGY:

• Researchers conducted a retrospective cohort study of 2083 adult SOT recipients (40.4% women; 30.6% non-Hispanic White, 24.6% Hispanic, and 44.8% Asian, Black, or individuals of other race and ethnicity), matched 1:20 with 26,199 nonrecipients from Kaiser Permanente (KP) Northern California between January 2016 and March 2023.
• The analysis compared preimplementation (2016-2021) and postimplementation (2022-2024) periods of the KP-SUNTRAC program, a modified version of SUNTRAC that included primary care, dermatology, and transplant specialties.
• Patients were stratified into low-, medium, high-, and very high-risk categories using KP-SUNTRAC model, and high- and very high-risk recipients were targeted for annual dermatology screenings.
• Outcomes included first detected skin cancer after transplant; first skin cancer screening; and resource use before and after implementation of KP-SUNTRAC.

TAKEAWAY:

• SOT recipients showed a 7.8-fold increased risk for skin cancer compared with matched nonrecipients (hazard ratio [HR], 7.78; 95% CI, 5.97-10.10)
• After implementation of KP-SUNTRAC, the risk for first-detected skin cancer increased 2.6-fold in transplant recipients (HR, 2.57; 95% CI, 1.76-3.73).
• The median time to first screening decreased from 10 months to 6 months among transplant recipients after implementation; screening rates also rose in high-risk (HR, 1.98; 95% CI, 1.39-2.82) and very high-risk groups (HR, 2.17; 95% CI, 1.21-3.86) compared with the pre-implementation period.
• Healthcare resource utilization showed no significant increase following program implementation.

IN PRACTICE:

“This cohort study confirms the elevated skin cancer risk in SOT recipients and supports the clinical utility of SUNTRAC in guiding risk-targeted cancer screening programs,” wrote the authors of the study. “Although the instrument was originally developed to be used by transplant teams to send timely referrals, this study demonstrates that dermatologists and primary care teams may also use SUNTRAC to triage SOT recipients and encourage timely skin cancer screening visits,” the author of an accompanying editorial wrote. “This study adds to the body of evidence on using a risk-based screening model to accurately identify the highest-risk patients, thereby focusing the utilization of healthcare resources,” the editorial noted.

SOURCE:

The study was led by David S. Lee, MD, Department of Dermatology, KP Northern California, Pleasanton, California, and was published online on October 15 in JAMA Dermatology. The accompanying editorial was authored by Anokhi Jambusaria-Pahlajani, MD, MSCE, of the Division of Dermatology, Department of Internal Medicine, Dell Medical School, University of Texas at Austin.

LIMITATIONS:

The study was conducted within a single regional health system with brief postimplementation follow-up period of 2.3 years. Screening and cancer data based on electronic records could underestimate cancer rates. Self-reported cases of pretransplant skin cancer lacked accuracy verification, and race and ethnicity categories might not reliably reflect skin phototype. The COVID pandemic potentially introduced detection bias due to clinic restrictions and greater hesitancy among transplant recipients to seek in-person care.

DISCLOSURES:

This study was funded by an award from The Rapid Analytics Unit, KP Delivery Science and Applied Research, The Permanente Medical Group. The authors reported having no relevant conflicts of interest. Jambusaria-Pahlajani reported consulting fees from Sun Pharma and Regeneron outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.