You can download this leaflet by clicking here

Patient Information Leaflet

Information about Skin Cancer for Patients with an Organ Transplant

What are the aims of this leaflet?

This leaflet has been written to help you understand the risk of developing skin cancer after receiving an organ transplant. It explains the importance of early detection and treatment of skin cancers. It describes the main types of precancerous and cancerous skin growths, how you can reduce the risk of getting skin cancer, and how skin cancer can be treated.

If you are going to have, or have had an organ transplant, it is important that you take good care of your skin. This is because people having transplants are more at risk of developing skin cancer than other people.

This leaflet gives you some advice on looking after your skin and provides
information on:

• The importance of early detection of skin cancers
• The importance of early treatment of skin cancers
• The way to decrease the risk of skin cancers

Why am I more at risk from skin cancer?

If you have had a transplant you will be given immunosuppressive drugs to prevent you rejecting the transplanted organ. These work by dampening down your immune (defence) system. However, these treatments also increase the risk of skin cancer and some benign tumours and infections.

How likely am I to get skin cancer ?

All transplant patients are at risk of developing skin cancer and the risk increases with time. For instance, twenty years after transplantation, more than half of all transplant patients will have had a skin cancer. Whilst all transplant patients are at risk, some are more likely than others to develop skin cancer. Patients with any of the following are at a higher risk than others:

• Fair skin that burns easily
• Light coloured eyes: blue, grey or hazel
• Blonde or red hair
• Numerous freckles
• Outdoor work or heavy sun exposure in the past
• History of skin cancer

On the other hand if you are of African, Arab, Asian, or Oriental descent you are much less likely to develop skin cancer than other transplant patients.

How can I spot signs of skin cancer?

Treatment will be much easier if your skin cancer is detected early.  Check your skin for changes once a month. You may need to use a mirror.  A friend or family member can help you with this. 

You should see your doctor if you have any marks on your skin which are:

• Growing
• Bleeding
• Changing in appearance in any way.
• Never healing completely

Below, we describe what skin cancers and related lesions look like.

Actinic keratoses (solar keratoses)

Skin cancers may be preceded by a pre-cancerous condition known as actinic (solar) keratoses. These are usually pink or red spots with a rough surface that appear on skin that is exposed to the sun. The head, face, back of the hands and forearms are affected most often.  They may be easier to feel (rough) than to see. Early treatment of actinic/solar keratoses may prevent them changing into skin cancer.

Basal cell carcinoma (rodent ulcer)

Most basal cell carcinomas are painless. People often first become aware of them as a scab that bleeds occasionally and does not heal completely. Some basal cell carcinomas are very superficial and look like a scaly red flat mark: others show a white pearly rim surrounding a central crater. If left for years, the latter type can “gnaw away” at the skin, eventually causing an ulcer – hence the name “rodent ulcer”. Other basal cell carcinomas are quite lumpy, with one or more shiny nodules crossed by small but easily seen blood vessels.

Squamous cell carcinoma

This is the most frequent cancer in organ transplant patients. It occurs most often on the head, neck, ears, lips, back of the hands and forearms. A squamous cell carcinoma usually appears as a scaly or crusty area of skin, with a red, inflamed base. It may look like an irritated wart. Most small squamous cell carcinomas are not painful.

Melanoma

Melanoma is a much rarer but the most serious skin cancer.  It is usually an irregular brown or black spot. It may start in a pre-existing mole or appear in previously normal skin.

Remember, if you see any change in your skin, whether an ulcer or a spot you must tell your doctor or nurse. Any skin problem that does not heal should be shown to a dermatologist (skin specialist).

How is skin cancer diagnosed?

If your doctor thinks that the mark on your skin needs further investigation, a small piece of the abnormal skin (a biopsy), or the whole area (an excision biopsy), will be cut out and examined under the microscope.  You will be given a local anaesthetic beforehand to numb the skin

How can I reduce the risk of getting skin cancer?

Many skin cancers can be avoided by changing your lifestyle. There are three main ways in which you can help to reduce your chance of getting skin cancer. These are:

• Learn how to recognise the early signs of skin cancer
• Examine your skin regularly for signs of cancer and get an annual check from your doctor or renal nurse
• Protect yourself from the sun

Exposure to the sun is the main cause of skin cancer in organ transplant patients.
This does not just mean sunbathing. You expose yourself to the sun each time you do any outdoor activities, including gardening, walking, sports, or a long drive in the car (even with the windows closed). The sun is a problem all year round not just in summer. 

You can take some simple precautions to help prevent a skin cancer appearing:

• Cover up. Wear a sun hat, long sleeves and trousers in sunny weather.
• Stay in the shade, particularly between 11 am and 3 pm.
• When outdoors use a sunblock of Sun Protection Factor (SPF) 25 or above and star rating *** or **** that protects against UVB and UVA and apply it every 2-3 hours.
• Remember that winter sun, such as on a skiing holiday, can contain just as much of the damaging ultra-violet light as summer sun.
• Don’t use sunbeds.

Can skin cancer be cured?

Most skin cancers, if treated early, can be cured. That is why it is important to report any new or changing skin lesion to your doctor. Basal cell carcinomas can be cured in almost every case and seldom, if ever, spread to other parts of the body. Treatment may be more complicated if they have been neglected for a very long time, or if they are in an awkward place - such as near the eye, nose or ear. In a few cases squamous cell carcinoma and melanoma may spread (metastasise) to lymph glands and other organs.

How can skin cancer be treated?

• Surgery – most skin cancers are excised (cut out) under a local anaesthetic. After an injection to numb the skin the tumour is cut away along with some clear skin around it.  Sometimes, a small skin graft is needed.
• Curettage and cautery – this is another type of surgery done under local anaesthetic where the skin cancer is scraped away (curettage) and then the skin surface is sealed (cautery).
• Cryotherapy – freezing the skin cancer with a very cold substance (liquid nitrogen).
• Creams – these can be applied to the skin. The two most commonly used are 5-fluorouracil (5-FU) and imiquimod.
• Photodynamic therapy – applying a cream to the skin cancer under a dressing for 4-6 hours  which destroys the skin cancer when a special light is shone onto it.
• The removal of lymph nodes – this is unusual but may be needed if there are
• concerns that the skin cancer has spread. 
• Radiotherapy – X-rays are shone onto the area containing the skin cancer. May also be used to relieve symptoms when a skin cancer has spread to other parts of the body.In some patients with more serious types of skin cancer, it may be advised that  their immunosuppressant medication is reduced or stopped. In some circumstances retinoid pills may be prescribed.

REMEMBER
Most cancers can be avoided if you follow these basic rules:

• • Check your skin for changes regularly
• • Report any skin changes to your doctor or nurse promptly
• • Always protect yourself from the sun

 

Where can I find out more about skin cancer?

British Association of Dermatologists Patient information Leaflets on

Actinic Keratosis
Basal Cell Carcinoma
Squamous Cell carcinoma
Melanoma

Macmillan Cancer Support
89 Albert Embankment
London SE1 7UQ

Free helpline for emotional support: 0808 808 2020
Free helpline for information: 0808 800 1234. Open Monday to Friday 9am to 8pm

Website: www.macmillan.org.uk

Cancer Research UK

Lincoln's Inn Fields, London, WC2A 3PX

Website : www.cancerresearchuk.org/sunsmart/

Wessex Cancer Trust

SCIN (Skin Cancer Information Network) and MARC'S Line (Melanoma and Related Cancers of the Skin)

Marc’s Line Resource Centre, Dermatology Treatment Centre, Level 3, Salisbury District Hospital, Salisbury, Wiltshire SP2 8BJ 

Tel: (01722) 415071
Fax: (01722) 415071 

Website: www.wessexcancer.org/support/scin.htm

The British Skin Foundation fund vital research into all skin diseases.  To find out how you can help, please visit the British Skin Foundation website here.

(While every effort has been made to ensure that the information given in this leaflet is accurate, not every treatment will be suitable or effective for every person. Your own doctor will be able to advise in greater detail). 

BRITISH ASSOCIATION OF DERMATOLOGISTS
PATIENT INFORMATION LEAFLET
PRODUCED AUGUST 2004