Compliance of Dermatology Screening Visits Among Patients With Skin Cancer-Predisposing Pathogenic Variants

Advances in genetic testing allow clinicians to identify patients with pathogenic variants that increase their risk of skin cancer. Whether this information results in more frequent dermatology screening visits as recommended by the National Comprehensive Cancer Network (NCCN) guidelines is unknown.

Our objective was to evaluate compliance with NCCN dermatology screening guidelines among patients with skin cancer-predisposing pathogenic variants and to determine whether visiting a Hereditary Cancer Clinic (HCC) would improve adherence to skin cancer screening.

We employed a retrospective observational cross-sectional design in a consecutive sample of 230 patients with pathogenic variants in BRCA1, BRCA2, Lynch syndrome genes (MLH1, MSH2, MSH6, PMS2) and other variants (ATM, CDKN2A, FLCN, MITF, POT1, PTEN, TP53) at the HCC at the Medical University of South Carolina. The sample was predominantly female (80%), Caucasian (82%) and non-Hispanic/Latino (94%) with a bimodal age distribution showing peaks around age 40 and 70. Compliance with NCCN dermatologic screening guidelines with a 6-month buffer period was measured, both before and after an HCC visit. Statistical significance was determined using the chi-squared proportion test.

Overall compliance with dermatology visits improved from 11.1% before HCC visits to 37% after visiting the HCC (p < 0.001). Factors associated with increased compliance included a personal (p = 0.09) and family history (p < 0.01) of non-melanoma skin cancer and age between 45 and 50 years old (p < 0.01). Among those receiving biopsies, 37.2% exhibited non-benign lesions. Lynch syndrome variants accounted for 50% of non-benign skin lesions.

HCC visits and personal and family history of skin cancer were associated with improved adherence to NCCN dermatology screening guidelines among patients with skin cancer-predisposing variants. Thus, dedicated HCCs could improve early detection and intervention of premalignant and malignant skin lesions. Additional studies that include a larger number of minority patients are required to confirm these findings.