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Abstract No. 4
Many patients receiving high‐dose phototherapy are not being reviewed
Author(s) -
Mackintosh L.,
Ashton C.,
Bilsland D.
Publication year - 2006
Publication title -
british journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.304
H-Index - 179
eISSN - 1365-2133
pISSN - 0007-0963
DOI - 10.1111/j.1365-2133.2006.07477_4.x
Subject(s) - medicine , general hospital , dermatology , library science , family medicine , computer science
Patients receiving high‐dose psoralen plus ultraviolet (UV) A (PUVA) have an increased risk of nonmelanoma skin cancer (Lim JL, Stern RS. High levels of ultraviolet B exposure increase the risk of non‐melanoma skin cancer in psoralen and ultraviolet A‐treated patients. J Invest Dermatol 2005; 124 : 505–13). The skin cancer risk associated with narrowband (NB) phototherapy is not yet known although mathematical models have been created to quantify the risk (Diffey BL. Factors affecting the choice of a ceiling on the number of exposures with TL01 ultraviolet B phototherapy. Br J Dermatol 2003; 149 : 428–30). Until recently, > 150 lifetime PUVA treatments and > 300 NB‐UVB treatments constituted a high dose of phototherapy. PHOTONET protocols suggest that an annual skin cancer check is carried out for patients in this category. The audit aims were to assess: (i) the number of patients receiving high‐dose phototherapy; (ii) if annual checks are being carried out in these patients; (iii) the numbers of skin cancers diagnosed in the group; and (iv) the number of patients on third‐line medication. Sixty‐six patients receiving high‐dose phototherapy were identified from the PHOTONET database; 60 case notes were available for review: 38 PUVA, 22 UVB. Sixteen of 60 are currently on third‐line therapy; an additional 30 of 60 have previously been on third‐line therapy. Six of 60 patients have developed skin cancer, all from the PUVA group. Four patients have developed nine squamous cell carcinomas, one of which has metastasized to regional lymph nodes. Two further patients have had one basal cell carcinoma each. Fourteen of 60 patients attend the photodermatology clinic for high‐dose checks, 14 of 60 attend general dermatology outpatients, three of 60 attend both clinics and 29 of 60 have no dermatology follow up. We have found that nearly 50% of patients receiving high‐dose phototherapy are not being reviewed at any dermatology clinic. Of the group being followed up 10% (16% of patients receiving PUVA) have had at least one skin cancer; this raises concerns about the group that has not been followed up. An annual high‐dose check at a dedicated clinic has a number of potential benefits. The consultation has a skin cancer focus and a full body examination including the genitals is carried out. We can take the opportunity to educate patients on skin self‐examination and early reporting of suspicious lesions. Finally, there should be a more focused approach to follow up of regular nonattendees, with correspondence to both patient and the general practitioner where necessary. In view of these findings, each patient receiving high‐dose phototherapy has been invited to attend for screening. The photodermatology clinic has been restructured to allow a monthly, dedicated high‐dose phototherapy clinic. We plan to repeat the audit cycle annually. This audit has demonstrated the use of the PHOTONET database in facilitating audit and highlighting clinical governance issues.