Rates of Dermatology Follow-Up and New Skin Cancer Diagnosis Among Solid Organ Transplant Recipients During the COVID-19 Pandemic

ABSTRACT

Purpose: Solid organ transplant recipients (SOTRs) are at an elevated risk of developing non-melanoma skin cancers. Routine dermatologic surveillance has been shown to improve skin cancer outcomes in SOTRs. However, the COVID-19 pandemic has had a profound impact on delivery of care. Among the general population, recent studies have found an increase in the number of teledermatology visits despite an overall decrease in dermatology visits, a decline in treatment adherence, and a stated preference for in-person care. The impact of the ongoing pandemic on dermatologic care in SOTRs, a high-risk population, remains largely unexplored. We sought to compare rates of usage of dermatology in-person and telemedicine services and new skin cancer diagnoses among SOTRs before and during the first wave of the COVID-19 pandemic in Los Angeles, CA. Method(s) A retrospective study was performed on patients who received solid organ transplants at Keck Hospital of USC between 2013-2018. The number of visits to our dermatology department during two 17-month time periods was counted 1) prepandemic, October 2018-March 2020 and 2) peri-pandemic, April 2020-September 2021. Each visit was categorized based on 1) general dermatology vs. Mohs surgery or follow-up and 2) in-person vs. telemedicine. Lastly, the number of new skin cancer diagnoses during these two time periods was counted. Result(s) Among a total of 1569 SOTRs, 154 patients had at least 1 dermatology visit in the pre-COVID 19 pandemic period, compared to 135 in the peri-pandemic period (p=0.241). While there was no significant decline in the mean number of general dermatology in-person visits per patient (p=0.266), there was a significant increase in general telemedicine visits during the same timeframe (p=0.026). Lastly, 11 new skin cancer diagnoses were made pre-pandemic, compared to 13 peri-pandemic (p=0.270). Conclusion(s) Our findings suggest our high-risk population of SOTRs did not experience significant disruption to routine delivery of dermatologic care during the first wave of the COVID-19 pandemic. Like prior studies, we found an increased reliance on teledermatology services, however without a concomitant decline in access to in-person care. Furthermore, the similar pre- and peri-pandemic rates of new skin cancer diagnoses do not raise concern for a future surge in skin cancer morbidity and mortality. By continuing to investigate the usage of dermatology services by SOTRs during the ongoing pandemic, we hope to address barriers to dermatologic care and prevent a rise in skin cancer morbidity and mortality. (Table Presented).