Skin Care - Post Transplantation

Organ transplant patients are at a higher risk — up to a 100-fold higher — for developing skin cancer compared to the general population.

Most skin cancers identified are called squamous cell carcinoma (SCC), but other cancers such as basal cell carcinoma (BCC) and melanoma also occur higher than in the general population.

This higher risk is caused by immunosuppressive medications, which are essential to transplant patients to prevent graft rejection and optimise graft survival.

These medications suppress the immune system, whose main function is to fight off infection and prevent the development of abnormal cells such as cancer. Transplant recipients are therefore at increased risk for infections and certain cancers. It is also important to remember that some other medications such as antifungal medications increase your skin sensitivity to sunlight, thereby burning much easier.

PROTECT YOUR SKIN AT ALL TIMES – Limit sun exposure

At 5 years after transplantation, 5% of transplant patients will develop skin cancer and that increases approximately 10% at 10 years.

What are the risks?

General risk factors

• History of significant sun exposure

• Fair skin, skin that burns easily, rarely tans.

• History of multiple blistering sunburns

• History of radiation exposure

Risk factors specific to transplant patients

Prior history of actinic keratosis (pre-cancers)
Prior history of skin cancer
Older age at transplant
Duration and intensity of immunosuppression
Type of organ transplant, heart and/or lung transplant patients are more susceptible

Prevention

At all times you should limit your exposure to the sun. This is best achieved by sun avoidance:

Avoid the sun between the hours of 10.00am and 4.00pm
Don’t stay in the sun for prolonged periods of time, even if you are wearing sunscreen.
Seek shade
Avoid solariums and sun beds
Even on overcast days remember that 80% of the sun’s UV rays reach you.

Sunblock

Apply 30 min prior to sun exposure
Apply to all sun-exposed areas. Don’t forget lips, ears, back of neck or back of legs
Apply a sufficient coat to sunscreen
Reapply every 2 hours, more frequent if in water or sweating
Use lip balm and frequently reapply
Long sleeve shirts and long pants and tight fabric weave
A white cotton T shirt only provides SPF of 5
Wear a broad-brimmed hat
Wear sunglasses with a UV protective coating. Wraparound glasses are the best

Protect your skin

For best protection, we recommend a combination of sun protection measures:

Slip on some sun-protective clothing – that covers as much skin as possible
Slop on a broad spectrum, water resistant SPF30+ sunscreen. Put it on 20 minutes before you go outdoors and every two hours afterward. Sunscreen should never be used to extend the time you spend in the sun.
Slap on a hat – broad brim or legionnaire style to protect your face, head, neck and ears
Seek shade
Slide on some sunglasses – make sure they meet Australian Standards

Extra care should be taken between 10.00am and 3.00pm when UV levels reach their peak.

Regular check-ups

Because of the increased risk all transplant patients are advised to have routine head to toe skin examinations. These should be performed at a minimum of once a year and for those with significant risk factors including a history of skin cancers, the checks should be more frequent.

The skin checks may be performed by a GP with an interest in skin, a specialist skin clinic, but more commonly by a dermatologist. If you are unsure or require a referral, be sure to discuss it with the transplant team.

In addition to these formal skin checks, you should frequently examine your skin for any changes or concerning lesions.

Resources

Cancer Council Australia

http://www.cancer.org.au/about-cancer/types-of-cancer/skin-cancer.html