You, too, can manage skin disease in solid organ transplant recipients

Arrive early for a seat at “Role of Dermatologist in Management of Skin Disease in Solid Organ Transplant Recipients” (S016), which will be presented from 9 a.m. to noon Saturday in Room 2004. Transplant dermatology is part of the Academy’s research agenda.

“Solid organ transplant patients have a plethora of dermatologic diseases that make them fascinating patients for the dermatologist,” said Fiona O’Reilly Zwald, MD, session director. “Skin can be a harbinger of a systemic issue. It can tell you whether the graft is failing or not.” The skin sometimes can even tell what medications patients are on or whether they are over-immunosuppressed. “If they are over-immunosuppressed they may get viral infections of the skin.”

Melanoma and squamous cell carcinoma (SCC) among these patients can be a huge challenge for transplant professionals. Solid organ transplant recipients are up to 65 times more likely to develop skin cancer than people without transplants. The role of dermatologists in taking care of these patients is key. “Our role is not only to identify skin disease and diagnose it, but also to treat it effectively, educate the patient in self-management and sunscreen use, and educate the other transplant professionals,” said Dr. Zwald, president of the International Transplant Skin Cancer Collaborative. Just as important, “understand that if you have aggressive skin cancer you need to move on it fast.”

Ten speakers will cover scientific advances in transplant dermatology during the session. One topic is the aggressive management of field disease. “When we manage field disease in these patients we are better able to control their emergent skin cancers,” said Dr. Zwald. The discussion will include the use of chemowraps and their side effects.

Another topic is the use of systemic therapy as prevention for melanoma. “We will look at small molecular inhibitors — the EGFR receptor inhibitors,” she said. Speakers will discuss medication side effects and their experience at the bedside — relevant information dermatologists can apply to their patients. “We can all read the research papers, but at this session we’ll have a group of speakers with hands-on knowledge about these drugs in practice.”

Staging and management of SCC will be addressed as well. “There are a lot of new staging mechanisms for squamous cell carcinoma,” Dr. Zwald said. “We’re looking at the use of sentinel lymph node biopsy in some of our more aggressive squamous cell carcinoma.”

Managing the skin disease of solid organ transplant recipients requires multidisciplinary care, said Dr. Zwald, who has a dedicated dermatology transplant clinic at Piedmont Transplant Institute in Atlanta. The challenge of caring for these patients can be met with dermatologists at the helm.

“For so long, care of these patients was always at the academic centers,” said Dr. Zwald. “When I give talks people are always worried, ‘Well, I can’t do this. I’m in private practice.’ The answer is yes you can. Some things are best done in an academic setting, but if you are in private practice and you’ve got a good network of colleagues, you can take care of these patients, and this is how you do it.”

Learn more about the Transplant Skin Cancer Network at aad.org.

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