Protect the Skin You're In

By Kara S. Nunley, MD, FAAD
Assistant Professor of Medicine (Dermatology)
Washington University in St. Louis

Did you know that skin cancer is the most common cancer to develop in organ transplant recipients? If your answer was no, you are not alone. Studies have shown that only about one-quarter of transplant recipients know that they are at increased risk for developing skin cancer. In this case, knowledge truly is power. By understanding your risk and the steps you can take to prevent and detect skin cancer, you can make a significant and positive impact on your health.

Organ transplant recipients, including kidney transplant recipients, have more skin cancers than the general population because the immunosuppressive medications that help to protect their transplanted organ also increase their risk for skin cancer.

Squamous cell carcinoma is the most frequent type of skin cancer found in transplant patients; it is 65 times more common in people with transplants than in people without transplants. Other forms of skin cancer, including basal cell carcinoma and melanoma, are also more common in transplant recipients.

When skin cancer is found early, it can often be easily treated. However, skin cancer can progress more rapidly and be more dangerous in transplant patients than in people who are otherwise healthy. Some transplant patients will develop many skin cancers and the surgery and medication required to treat these cancers can decrease their quality of life.

While all transplant patients are at risk for skin cancer, there are some factors that indicate substantially increased risk. These include: fair skin, light colored eyes and/or hair, extensive sun exposure, and personal or family history of skin cancer. Skin cancer does not usually develop immediately after transplantation. There is often a lag time of 3-7 years after transplant before skin cancers start to occur. Longer periods of time on immunosuppressive medications and higher doses of these medications are associated with increased risk of skin cancer. This means that kidney transplant patients, who often spend many healthy, active years on immunosuppressive medications need to be especially aware of ways to prevent skin cancer.

There are three important steps that you can take to reduce your risk of skin cancer:

  1. Protect yourself from the sun. Sun protection starts with regular use of sunscreen. Pick a sunscreen with an SPF of at least 30 - if you have had skin cancer or are very fair, a higher SPF of 50 or 75 may be preferable. It is important to use a sunscreen that is labeled "broad spectrum" - this means that it protects against UVA and UVB rays. All sunscreens should be applied 15-20 minutes before going outside, and they must all be reapplied every 2 hours. A higher SPF rating does not mean that the sunscreen will last longer than this. Reapplication after swimming or sweating is also recommended. Even "water-resistant" sunscreens need to be reapplied after 40-80 minutes. Using a large enough quantity of sunscreen is also important - most people only use half of the recommended amount. Sun-protective clothing and hats are great ways to get long-lasting protection throughout the day. A regular white t-shirt does not provide much protection, but newer lightweight UV-protective clothing can provide great protection throughout the day. Seeking shade between the hours of 10 am and 4 pm, and using extra caution around water, sand, and snow are also important.
  2. Perform skin self-exams. In addition to practicing effective sun protection, it is important to examine your own skin once a month. This way any worrisome spots that do occur can be identified and treated without delay. You will often be the first person to notice a new or changing skin lesion. When you check your skin, be sure to look at all areas including your scalp, hands, feet, genitals, and even your nails. Skin cancer can even occur in areas that are not exposed to the sun. Having a partner or friend look at areas that are difficult to see can be helpful. You should seek medical attention for any red or scaly areas, bleeding or scabbed spots, painful lesions, or changing moles.
  3. See a dermatologist for a full skin examination. Even if you do not notice any areas of concern on your skin, you should have a doctor check all of your skin at least once a year. Your doctor may be able to find skin cancers and precancerous lesions before they become visible to you. Patients who have multiple skin cancers may need to see their dermatologist more frequently, even up to once a month. For higher risk patients, there are medications and treatments that can be used to address precancers and decrease the rate of skin cancer development.

Being an organ transplant recipient puts you at higher risk for skin cancer. The good news is that you can reduce this risk. With skin self-exams, regular dermatologist visits, and good sun protection, you can make a difference in finding and preventing skin cancer.