Introduction: Skin cancer is one of the most common forms of cancer in the United States of America. Incidence of melanoma in patients diagnosed with Inflammatory Bowel Disease (IBD) had a reported 37% increase in risk of melanoma when compared to the general population. It was seen that IBD was associated with an increased risk of melanoma, independent of biologic therapy. According to preventative care guidelines, patients with IBD should undergo screening for melanoma independent of the use of biologic therapy.
Methods: A random sample of patients were collected from a database within a tertiary care center. Patients were selected by having a confirmed diagnosis of Ulcerative Colitis (UC) or Crohn’s Disease (CD) and having an established relationship with an internal medicine resident or non-teaching internist clinic. General demographics, referral to Dermatology and specific department from where the referral was placed were collected, along with relevant clinical information including current and previous therapies for IBD.
Results: A total of 109 patients met inclusion criteria. Of the 60 patients who were cared for at the resident teaching clinic, 14 were referred to dermatology. Referrals were mostly made by a consulting gastroenterologist (11 out of 14 referrals). Only 8 out of the 14 patients that were referred successfully followed through with a dermatology clinic. Of the 49 patients who were cared for at the non-teaching internist clinic, 8 were referred to dermatology, all of whom were referred by the consulting gastroenterologist. Six out of the 8 patients followed up with dermatology. In general, CD patients were significantly more likely to be referred to dermatology compared to UC patients (p< 0.05). Patients who are currently or were previously on biologic therapy were significantly more likely to be referred to dermatology compared to those who have no history of biologic use (p< 0.05).
Discussion: Based on this descriptive study, overall screening for dermatological cancers in the IBD at-risk population is low despite their care being provided at a tertiary care center with access to consultants. This signifies gaps of care and low adherence to practice guidelines. The limitations need to be further studied as we speculate that the reason for low adherence could include deficiency in awareness of guidelines among primary care clinics, gastroenterologist reliance on primary care for general health maintenance, and insufficient patient education regarding the risks of skin cancer.
