Transplant patients need to be made aware of skin cancer risk

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7332.296 (Published 02 February 2002) Cite this as: BMJ 2002;324:296
  1. Vandana S Ramrakha-Jones, specialist registrar, dermatology (davana{at}doctors.org.uk)
  1. Dermatology Department, Royal Hospital for Sick Children, Yorkhill NHS Trust, Glasgow G3 8SJ

    EDITOR—Harden et al in their survey of skin cancer surveillance in recipients of renal transplants have highlighted the fact that monitoring of these patients is inadequate.1 They say that patient information does not necessarily correspond to patient awareness. Despite being given information on skin cancer, many patients remain unaware of the risks of ultraviolet radiation and do not adopt long term sun protection measures.2

    The risk of non-melanoma skin cancer in renal transplant patients increases steadily with length of time since transplantation.3 In this group skin cancer presents earlier and is more aggressive. It is therefore important to target the paediatric transplant population. We performed a questionnaire survey of the cohort of 39 Scottish paediatric patients who received kidneys between 1987 and 2000.4 We aimed to assess parents' awareness of the need for sun protection, the sun protection measures used, and their children's attitudes to the sun. We sent a questionnaire to each child and parent.

    Twenty six of the 39 (67%) questionnaires were returned. The patients were aged 6-17 years, and time since transplant varied from 6 months to 13 years. Whereas 24 of the 26 parents were aware that their child needed sun protection, only six were aware of their child's specific increased skin cancer risk as a result of immune suppression. Twenty four of the 26 children had sunscreen applied to exposed areas when on holiday. Far fewer used the more effective measures of wearing protective clothing (11) or avoiding the midday sun (4). Only a small proportion (6) used these measures daily during the British summer. Not surprisingly, most children (25/26) liked the sun. It is worrying that seven of them actively sought the sun to get a tan and that seven recalled having had sunburn. Only 13 of the children knew that there was a risk of their skin being damaged by the sun. The problem of non-melanoma skin cancer in transplant recipients needs to be highlighted.

    Children with renal transplants are a particularly vulnerable group. The need for adequate and appropriate sun protection in this group needs to be emphasised by all professionals participating in their care.


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