Seasonal variations in hospital admission for deep vein thrombosis and pulmonary embolism: analysis of discharge data.

no difference in the proportion of surgical or nephrology centres that provided skin cancer surveillance , full skin examination, or specific training for clini-cians performing surveillance (table), regardless of the size of the unit (data not shown). Comment Skin cancer surveillance is available only to a minority of UK renal transplant recipients. We found no difference between surveillance strategies in surgical and nephrology centres. Surveillance of individuals with atypical mole syndrome in the general population is well established. 4 Such people have an estimated cumulative 10 year risk of melanoma of 11%, compared with a 32% prevalence of non-melanoma skin cancer in transplant recipients. 1 Guidelines for annual screening of renal transplant recipients for non-melanoma skin cancer were recently established in the United States. 3 We previously showed the benefit of nurse led surveillance in the United Kingdom , which facilitates earlier diagnosis and treatment of non-melanoma skin cancer, with a potential reduction in morbidity and mortality. 2 Clinicians doing surveillance must have adequate training to maintain clinical competence; current levels of training are inadequate. Non-melanoma skin cancer often occurs on covered body sites (20% of cases 1); such lesions could be missed in centres doing only limited skin examination. Although advice and literature on avoidance of ultraviolet light are given at the time of transplantation, only a minority of patients remain aware of the risks and adopt adequate sun protection measures long term. 5 Education of patients should start as soon as transplantation is recognised as a potential treatment and should continue long term. All transplant recipients should have skin cancer surveillance, and all clinicians (general practitioners, specialist physicians and surgeons, and nurses) caring for transplant recipients should be aware of the risks. The higher prevalence of non-melanoma skin cancer in renal transplant recipients compared with the general population is largely due to long term immunosuppres-sion. The prevalence of skin cancer is therefore also likely to be increased in patients taking immunosuppres-sion for a range of non-renal clinical conditions. We thank all of the nephrologists, transplant surgeons, specialist nurses, and transplant coordinators throughout the United Kingdom who completed and returned the questionnaires. Contributors: PNH conceived and designed the study, wrote the draft manuscript, and is the guarantor for the paper. SMR distributed the questionnaires and liaised with individual units. AAF did the statistical analyses and collated the database. AGS advised on dermatological aspects of the study. HMR helped to …