Long-term immunosuppressive therapy can significantly increase the risk and mortality of skin cancer in organ transplant recipients (OTRs).
Previous research shows that specific educational interventions can boost the use of sunscreen and other sun protection measures in OTRs. A new research letter shows that merely participating in a skin cancer research study for at least a year — even one without specific educational interventions — can increase the practice of multiple sun protection behaviors in recipients.
The number of organ transplants is rising. There were only 15,756 transplants in 1991, compared with 34,770 in 2017, according to the U.S. Department of Health and Human Services.
Surgeons currently perform about 95 transplants each day. Survival rates among organ transplant recipients are increasing as well. Better primary skin cancer prevention among organ transplant recipients can reduce skin cancer burden among this growing population.
The most common types of skin cancer in OTRs are squamous cell carcinoma (SCC), basal cell carcinoma (BCC), melanoma and Merkel cell carcinoma (MCC), in that order, according to the Skin Cancer Foundation.
The risk of SCCs is about 100 times higher for an OTR than the general population’s risk, and the risk of BCC is six times higher. Employing sun protection measures reduces this risk.
The Use of Sun Protection Measures in OTRs after Participating in a Study
Researchers enrolled 225 participants from into an Australian retrospective cohort study, known as the Skin Tumours and Allograft Recipients study. Participants were kidney and liver transplant recipients at a high risk of skin cancer.
The participants completed surveys upon enrollment into the study, annually, and upon exiting the study. Mean follow-up was 36 months.
The researchers also recorded the participants’ complexion type rather than their ethnicity. The eligibility criteria excluded those with dark brown or black innate skin type.
The researcher team looked at the participants’ use of sunscreen, hats and long-sleeve shirts. They defined multiple measures of sun protection as the use of two or more of those measures more than 50 percent of the time outdoors.
The scientists found some commonalities between participants who used multiple sun protection measures at baseline. Specifically, participants who already used a variety of sun-blocking measures were significantly more likely to have been born in Australia and to have fair complexions rather than medium or olive. The participants using multiple sun protection measures were also more likely to have had annual skin cancer screening as recommended during the previous five years.
The research team also found that, at an odds ratio of 4.4, the use of multiple sun protection measures increased substantially between enrollment into and exit from the study. The odds of applying sunscreen increased, with an odds ratio of 1.7. Participants were also likely to adopt the habit of wearing long sleeves and hats.
"These results suggest that research clinics that conduct skin cancer surveillance among organ transplant recipients offer additional educational and primary prevention advantages beyond improved access to care," write the authors.
The scientists published their research letter online in JAMA Dermatology.
