P N Harden, S M Reece, A A Fryer, A G Smith, H M Ramsay
Harden P N, Reece S M, Fryer A A, Smith A G, Ramsay H M.
Skin cancer surveillance in renal transplant recipients: questionnaire survey of current UK practice
BMJ 2001; 323 :600
doi:10.1136/bmj.323.7313.600
Transplant patient awareness of skin cancer risk
EDITOR - Harden et al’s survey of skin cancer surveillance in renal
transplant recipients has highlighted the fact that monitoring of these
patients is inadequate.(1) They rightly comment 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. 26/39 (67%) of our
questionnaires were returned. The patients were aged 6 to 17 years, and
time since transplant varied from 6 months to 13 years.
Whereas 24/26 (92%) parents were aware that their child needed sun
protection, only 6/26 (23%) were aware of their child’s specific increased
skin cancer risk due to immune suppression. 24/26 children had sunscreen
applied to exposed areas when on holiday. Far fewer used the more
effective measures of wearing protective clothing (11/26) or avoiding the
midday sun (4/26). Only a small proportion (6/26 or 23%) used these
measures daily during the UK summer. Not surprisingly, the majority of
children (25/26) liked the sun. It is worrying that 7/26 (27%) of
children actively sought the sun to get a tan, and 7/26 of them recalled
having had sunburn. Only 13/26 (50%) of the children knew that there is 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
involved in their care.
1. Harden PN, Reece SM, Fryer AA, Smith AG, Ramsay HM. Skin cancer
surveillance in renal transplant recipients: a questionnaire survey of
current UK practice. BMJ 2001; 323: 600-1.
2. Seukeran DC, Newstead CG, Cunliffe WJ. The compliance of renal
transplant recipients with advice about sun protection measures. Br J
Dermatol 1997; 138: 301-3.
3. Webb M, Compton F, Andrews P, Koffman C. Skin tumours post
transplantation: a retrospective analysis of 28 years’ experience at a
single centre. Transplant Proc 1997; 29: 828-30.
4. Jury CS, Jones VSR, Maxwell H, McHenry P. Awareness of sun
protection measures in paediatric kidney transplant patients and their
families. Br J Dermatol 2001, 145 (Suppl 59): 125-6.
Competing Interests: None
Competing interests: No competing interests