Skin Cancer in Patients on Long-Term Immunosuppression


Why do I need to know about skin cancer?

The immunosuppressive medication you are on can dampen down your body’s defences against ultraviolet light.

You are, therefore, at increased risk of developing skin cancer. This risk will increase over the years you are on immunosuppressive medication.

Patients with any of the following are at higher risk than others:

  • history of skin cancer or pre-cancer (actinic keratoses)
  • fair skin that burns easily and tans poorly
  • history of excess exposure to foreign sunlight
  • outdoor hobbies or occupation
  • history of excessive sunbed use
  • family or personal history of melanoma

What should I do about this?

You should examine your skin regularly for any unusual changes or growths or non-healing areas (have a friend or family member check your back). If you detect anything unusual, consult your doctor as soon as possible.

Follow the following guidance for sun avoidance:

  • Stay indoors or seek the shade between the hours of 11.00am and 3.00pm from April to September, when the sun’s rays are strongest
  • When out in the sun, wear a broad-brimmed hat, that protects your face, neck and ears and clothing made of a tightly woven fabric that you cannot see through.
  • Avoid sunbed use
  • Wear a sunscreen every day (even on overcast days) on exposed skin from the end of March until the end of September and on winter holidays (eg skiing).
  • If you are on Azathioprine, you should wear a sunscreen all year round.

What type of sunscreen should I use?

Choose a sunscreen with a high protection SPF (SPF 30 or more) to protect against UVB, and the UVA circle logo and/or 4 or 5 UVA stars to protect against UVA.

How should I use my sunscreen?

Most people apply too little sunscreen; do apply it liberally.

You should apply the sunscreen evenly to clean dry skin, ideally twice, allowing it to soak in before you go out. You will get much more benefit from your sunscreen if you apply it twice. To remain effective, the sunscreen should also be re-applied after swimming, towelling down, exercise or heavy perspiration.

Apply your sunscreen even if you will be sitting in the shade, as surfaces such as sand, water, snow and concrete can reflect the sun’s rays onto your skin while you are in the shade.

Be aware that even total sunblocks do not offer complete protection and you should rely more on altering your behaviour and covering up.

What about Vitamin D?

Avoiding sunlight exposure may be associated with Vitamin D deficiency. You might wish to consider having your Vitamin D level checked; if the level is reduced, your doctor may recommend a supplement of Vitamin D3 (10 – 25 microgrammes per day). Foods high in Vitamin D include oily fish, eggs, meat, fortified margarines and cereals.