Transplant recipients come to dermatology when something appears. The lesion that kills them is usually a keratinocyte cancer that was there for a while and did not look alarming, on a patient whose immunosuppression means it behaves nothing like the same lesion on an immunocompetent person.
The habit worth building is asking the date of the last complete skin examination at every contact — including contacts for something unrelated, and including contacts in the transplant clinic rather than yours. Most recipients do not have a scheduled interval; they have an intention.
And set the expectation early, at transplant rather than at first lesion. Sun protection advice delivered after a first squamous cell carcinoma arrives years too late to change the field damage that produced it.
- Ask the date of the last full skin check at every contact with a transplant recipient
- Put a specific interval in the letter rather than advising regular review
- Deliver photoprotection advice at transplant, not at first lesion
- Keratinocyte cancer, not melanoma, is where most of the excess mortality sits
- Treat a new keratotic lesion in a transplant recipient with more urgency than the same lesion otherwise
Why it matters
Surveillance in this group usually exists as an intention rather than as a booked appointment.
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