LOS ANGELES — Survivors of hematopoietic cell transplantation face a significantly heightened risk of skin cancer, yet many do not receive regular skin examinations once they leave specialized transplant care. New research from City of Hope suggests that a low-cost, technology-enabled education program aimed at both patients and primary care physicians can substantially improve skin cancer screening in this medically vulnerable population.
The randomized controlled trial, known as the Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT study, or TEACH, included 720 hematopoietic cell transplant survivors. The findings, published in JNCCN—Journal of the National Comprehensive Cancer Network, indicate that simple educational materials delivered by mail and reinforced through text messages can increase both self-examination and physician-performed skin checks. The results point to a practical strategy for extending survivorship care beyond major cancer centers.
Hematopoietic cell transplantation, also called bone marrow or stem cell transplantation, replaces damaged or diseased blood-forming cells with healthy cells. The procedure is used to treat leukemia, lymphoma, multiple myeloma and other blood cancers, as well as nonmalignant conditions such as aplastic anemia and sickle cell disease. Although transplantation can be lifesaving, the intensive chemotherapy, radiation, immune suppression and long-term immune-system disruption associated with the procedure can produce delayed complications, including an elevated risk of secondary cancers.
Among these complications, skin cancer is particularly important because it can often be detected during routine examinations or by patients themselves. HCT survivors face nearly twice the risk of squamous cell carcinoma compared with the general population, while basal cell carcinoma, melanoma and Merkel cell carcinoma are also concerns. Skin cancers may begin appearing three to five years after transplantation, when many survivors have already transitioned from transplant specialists to primary care providers. This change in care setting can create gaps in surveillance, particularly when patients and physicians are unaware of the specific risks associated with HCT.
The City of Hope intervention was designed to address both sides of that problem. Every participant received mailed educational materials explaining why HCT survivors are at increased risk, how to conduct a systematic self-examination and what suspicious lesions may look like. The materials included images to help participants recognize warning signs such as a changing mole, a new growth, a sore that does not heal or a lesion with unusual color or irregular borders. All participants also received recurring text messages intended to reinforce the information and encourage continued screening behavior.
Approximately half of the participants were assigned to an additional physician-activation group. In that group, the patients’ primary care doctors received information describing the relationship between HCT and skin cancer, along with guidance on conducting full-body skin examinations. This provider-focused component was intended to make skin surveillance a routine part of primary care rather than a responsibility that ends when a patient leaves the transplant clinic.
The investigators reported that the proportion of survivors completing skin self-examinations and receiving annual clinical skin checks nearly tripled overall during the study. Patient education alone produced a clear improvement in self-examination, suggesting that survivors can become active participants in detecting possible cancers when they receive specific instructions and visual examples. The intervention did not depend on frequent specialist appointments, expensive equipment or intensive counseling, making it potentially adaptable to large survivor populations.
The strongest difference emerged when physicians were included in the intervention. Although self-examination increased among participants across the study, the proportion who also received an in-office skin examination was 40 percent higher when their primary care physicians had received the educational materials. The finding suggests that patient awareness may be sufficient to encourage personal monitoring, while physician education is especially important for ensuring that a professional examination takes place.
“This study shows that practical, scalable solutions can close that gap and may be applicable to other long-term complications in cancer survivors,” said Saro Armenian, D.O., M.P.H., the study’s first author and director of the Center for Survivorship and Outcomes at City of Hope. He said the results are already informing how the institution approaches follow-up care, particularly as survivors move from specialty settings into primary care. The model combines patient activation, clinician education and remote communication to support risk-based survivorship care without requiring a high-intensity intervention.
The researchers say the approach could be expanded to address other late effects of transplantation, including cardiovascular disease, bone loss, chronic immune complications and second malignancies. Its broader significance lies in the way it connects specialized cancer knowledge with routine medical care: survivors receive tools to monitor their own health, while primary care physicians receive the context needed to recognize risks that may not be apparent from a standard medical history. Supported by the National Cancer Institute through grant R01 CA249460, the study reinforces the principle that successful cancer treatment is not the end of care, but the beginning of long-term surveillance designed to protect survivors for decades after transplantation.
Subject of Research: Skin cancer screening among hematopoietic cell transplant survivors
Article Title: Technology-Enabled Patient and Physician Activation to Enhance Skin Cancer Screening After HCT (TEACH Study): A Randomized Controlled Trial
News Publication Date: 6-Aug-2026
Web References: https://jnccn.org/view/journals/jnccn/aop/article-10.6004-jnccn.2026.7030/article-10.6004-jnccn.2026.7030.xml
References: National Cancer Institute grant R01 CA249460; JNCCN—Journal of the National Comprehensive Cancer Network
Keywords: Skin cancer, hematopoietic cell transplantation, bone marrow transplantation, stem cell transplantation, cancer survivorship, skin cancer screening, squamous cell carcinoma, melanoma, primary care, patient education, physician activation, survivorship care
