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Most Organ Transplant
patients are unaware of their increased risk
for Skin Cancer
Newswise — As the number
of organ transplants continues to increase
throughout the world, so too are the number
of organ transplant recipients developing
skin cancer.
Due in large part to the
immunosuppressive medications required to
prevent organ rejection, skin cancer among
patients receiving solid organ transplants –
such as kidney, heart, liver, or lung, among
other organs – also tends to be more
aggressive and spreads more quickly than in
other patients.
Now, new research
demonstrates the need for more comprehensive
patient education and management of skin
disease in transplant patients to try to
reverse these rising skin cancer rates.
Speaking today at the 66th
Annual Meeting of the American Academy of
Dermatology (Academy), dermatologist Summer
R. Youker, MD, FAAD, assistant professor of
dermatology at Saint Louis University School
of Medicine in St. Louis, Mo., discussed the
reasons why organ transplant patients failed
to see a dermatologist and did not practice
proper sun protection, despite educational
efforts advising these practices.
“Educating transplant
patients about the risk of skin cancer is
essential, but multiple studies have shown
that education during their hospital stay is
not retained by patients and is not enough
to change patient behavior regarding sun
protection,” said Dr. Youker.
“Our findings confirmed
that the majority of transplant patients
surveyed did not know they were at risk of
developing skin cancer, and many of the
reasons they gave for not practicing proper
sun protection or seeing a dermatologist
could be remedied by developing an intensive
educational approach that raises awareness
of the prevalence of this real health
threat.”
In 2006, there were 29,000
solid organs transplanted, contributing to a
total of 223,000 people living with
functioning organ transplants in the United
States at the end of that year.
The incidence of skin
cancer in solid organ transplant recipients
is up to 200-fold that of age-matched
controls due mostly to the required
immunosuppressive medications.
Dr. Youker cited studies
that show that as many as 82 percent of
kidney transplant recipients develop skin
cancer 20 years after transplantation, and a
study of Australian heart transplant
recipients found that 27 percent of deaths
occurring four years after transplantation
were due to skin cancer.
In Dr. Youker’s study, a
total of 298 solid organ transplant patients
(65 percent males and 35 percent females)
who attended the outpatient transplant
clinics at Saint Louis University completed
a two-page survey to evaluate their
comprehension of skin cancer risk, their
compliance with skin cancer preventive
measures, and their attitudes about
sunscreen use and skin screenings.
Dr. Youker reported that
62 percent of respondents did not know they
were at risk for skin cancer, and 73 percent
of respondents stated that they were not
informed about the risk of skin cancer
following their organ transplant.
In fact, only 21 percent
of patients had seen a dermatologist since
their transplant, with even less (14
percent) receiving annual skin exams.
Of the reasons respondents
gave for not seeing a dermatologist, 64
percent said they “did not know about the
increased risk” and 7 percent said that they
“do not want to attend another doctor’s
appointment.”
Only 28 percent of
respondents reported wearing sunscreen
regularly, a slight increase from 22 percent
who reported wearing sunscreen regularly
before transplantation.
Reasons for not wearing sunscreen varied
widely among survey participants – 33
percent responded “I forget to put it on,”
25 percent said “I don’t think it is
important to use sunscreen,” 16 percent said
they are “not in the sun very much,” 11
percent said “I like looking tan,” 8 percent
said they “don’t like the way it feels,” and
5 percent said it “takes too much time to
put on.”
“Because the time around
an organ transplantation is consumed with
the more pressing issues of rejection and
infection, patients cannot be expected to
recall information regarding the risks of
sun exposure,” explained Dr. Youker.
“Clearly, another method
of informing patients of this risk is needed
– preferably one involving dermatologists,
who can assist the transplant team with
strategies to educate and treat this
high-risk patient population.”
Dr. Youker cited a related study,
“Educational Outcomes Regarding Skin Cancer
in Organ Transplant Recipients,” published
in the June 2006 issue of the Archives of
Dermatology, that found that the patients
who received an intensive educational
program in which written reminders
reinforced the risk of skin cancer fared
significantly better in terms of complying
with the recommended sun protection tips
than those patients who did not receive this
education.
“Regular correspondence
with transplant patients concerning the risk
of skin cancer and referral to a
dermatologist for initial skin screening,
assessment of risk factors and detailed
education about skin cancer prevention could
help reduce the incidence of skin cancers in
these patients,” added Dr. Youker.
Sun exposure is the most
preventable risk factor for skin cancer. The
Academy recommends that everyone follow
these sun protection guidelines:
• Generously apply a water-resistant
sunscreen to all exposed skin using a Sun
Protection Factor (SPF) of at least 15 that
provides broad-spectrum protection from both
ultraviolet A (UVA) and ultraviolet B (UVB)
rays. Re-apply every two hours, even on
cloudy days, and after swimming or sweating.
Look for the AAD SEAL OF RECOGNITION™ on
products that meet this criteria.
• Wear protective
clothing, such as a long-sleeved shirt,
pants, a wide-brimmed hat and sunglasses,
where possible.
• Seek shade when
appropriate, remembering that the sun’s rays
are strongest between 10 a.m. and 4 p.m. If
your shadow is shorter than you are, seek
shade.
• Use extra caution near
water, snow and sand as they reflect the
damaging rays of the sun which can increase
your chance of sunburn.
• Protect children from
sun exposure by applying sunscreen.
• Get vitamin D safely
through a healthy diet that may include
vitamin supplements. Don’t seek the sun.
• Avoid tanning beds.
Ultraviolet light from the sun and tanning
beds can cause skin cancer and wrinkling. If
you want to look like you’ve been in the
sun, consider using a sunless self-tanning
product, but continue to use sunscreen with
it.
• Check your birthday suit
on your birthday. If you notice anything
changing, growing, or bleeding on your skin,
see a dermatologist. Skin cancer is very
treatable when caught early.
For more information about
skin cancer, visit
www.skincarephysicians.com and click on
“SkinCancerNet.”
In 2001, the International
Transplant Skin Cancer Collaborative (ITSCC)
was founded to educate patients, scientists,
primary care doctors and specialist
physicians on the unique needs and clinical
care issues in transplant patients.
The organization’s Web
site serves as an important source of
information on patient education, available
clinical trials, and an extensive relevant
bibliography. For more information, visit
http://www.itscc.org.
Headquartered in
Schaumburg, Ill., the American Academy of
Dermatology (Academy), founded in 1938, is
the largest, most influential, and most
representative of all dermatologic
associations.
With a membership of more
than 15,000 physicians worldwide, the
Academy is committed to: advancing the
diagnosis and medical, surgical and cosmetic
treatment of the skin, hair and nails;
advocating high standards in clinical
practice, education, and research in
dermatology; and supporting and enhancing
patient care for a lifetime of healthier
skin, hair and nails. For more information,
contact the Academy at 1-888-462-DERM (3376)
or
http://www.aad.org.
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