Preventing skin cancer

Skin cancer is the most common type of cancer in transplant recipients. Recipients have a higher chance of non-melanoma skin cancer, which includes squamous cell and basal cell cancers.

This is because the immunosuppressants you take make it less likely for your immune system to find and destroy cancer cells. Also, your skin is more sensitive to sunlight due to:

Immunosuppressants

Some prescription or over-the-counter drugs like antibiotics

Talk to your transplant team or primary care provider about how your medicines can raise your chances of skin cancer.

The sun’s ultraviolet (UV) rays can damage your skin in as little as 15 minutes – even on cloudy days!

Follow the recommendations below to protect yourself from the sun.

Find shade and avoid sunlight at certain times

It is best to avoid being in the sun during the middle of the day, between 10am-4pm when the sun is most intense.

Most sunscreen products work by absorbing, reflecting, or scattering sunlight. They contain chemicals that interact with your skin to protect it from UV rays. All products do not have the same ingredients, so if your skin reacts badly to one product, try another one.

Always choose sunscreens based on these important factors:

SPF: Only use sunscreen with 30 SPF or higher. All sunscreens have a sun protection factor (SPF) number that rates how well they block UV rays. Higher numbers mean more protection.
Broad-spectrum: Use a broad-spectrum sunscreen, which means it protects you from the sun’s UVA and UVB rays, which both hurt your skin in different ways.
Expiration date: If a sunscreen is past it’s expiration date, it no longer works. If it doesn’t have an expiration date, assume it no longer works after 3 years.

To put sunscreen on correctly:

Put a thick layer on all parts of your skin that will be in the sun.
If you use spray sunscreen, be sure to rub it in after you spray it!
Get help for hard-to-reach places like your back.
Reapply every 2 hours when you’re in the sun, and more often when you’re swimming or sweating.

And remember, sunscreen works best when combined with other ways to protect you from UV rays, like hats, clothing, and sunglasses!

Choose the right clothing

When outside, wear long-sleeved shirts and long pants and skirts to protect you from UV rays. This is important because sunscreens don’t completely protect you from the sun’s UV rays.

Here are some tips for finding the most protective clothing:

Color: Thicker, darker fabrics are more protective than thinner, light fabrics.
Weave: Clothes with tightly woven fabric offer the best protection – this means fewer little holes for the sun’s rays to pass through. And dry clothes protect you more than wet clothes.
Fibers: In general, synthetic and blended-composition fabrics are better than fabrics made of natural fibers, such as 100% cotton.
Fit: Looser-fitting clothes are more protective than tighter fits. If fabric is tight, it can stretch against your skin, creating gaps in the fiber to let in more UV rays.
Coverage: Choose clothing that covers more of your skin to protect you more!

If your recovery is going well, after 8 weeks, your transplant team may recommend moderate activity, such as walking, jogging, swimming, or cycling. Some sports may be safe, but you should avoid heavy contact sports, for example rugby, martial arts, or boxing, as these may hurt your new organ.

Always talk with your transplant team or primary care doctor before starting an exercise plan. They can help you find exercises that are safe for you to do after your transplant.

UPF rating

You can also choose clothing with a high UPF rating. UPF tells you what fraction of the sun’s UV rays get through the fabric.

The Skin Cancer Foundation recommends a UFP rating of 30 or higher. Dark denim has a UPF of about 1,700, which is almost complete sun protection. While a white T-shirt only has a UPF of about 7, and drops to 3 when it gets wet.

Here are a few ways to test your clothing:

Hold it up to the light – if you can see through it, it is not protecting your skin!
Use a photochromic UV-intensity card to check how much UV gets through to your skin.

Wear hats

For the most protection, wear a hat with:

A brim all the way around that shades your face, ears, and the back of your neck. If you wear a baseball cap, protect your ears and the back of your neck with sunscreen.
Tightly woven fabric, such as canvas. Avoid straw hats with holes that let the sun’s UV rays through.
A darker color

Wear sunglasses

Sunglasses protect your eyes from the sun’s UV rays and lower your chance of cataracts. Also, the skin around your eyes is more sensitive and needs protection.

You want sunglasses that block both UVA and UVB rays, which is the standard for most sunglasses sold in the United States. And consider wrap-around sunglasses that block UV rays from sneaking in from the side.

See a dermatologist

See a dermatologist regularly who specializes in treating transplant recipients. A specialist will understand your unique needs and can work with your transplant team to adjust medicines to lower your chance of skin cancer.

Check your skin each month

You can spot warning signs of skin cancer early, when it’s small and easier to treat.

Doctors recommend that you check your own skin about once a month. Here are a few tips:

Look at your skin in a well-lit room
Look in front of a full-length mirror and use a hand-held mirror for areas that are hard to see
Ask someone to help you look at areas that you can’t see

In general, look at any spots, moles, freckles, bumps, or birthmarks. Look for:

Any new spots or growths
Any spot that doesn’t look like others on your body
Any sore that doesn’t heal
Redness or new swelling beyond the border of a mole
Color that spreads from the border of a spot into surrounding skin
Itching, pain, or tenderness in an area that doesn't go away or goes away then comes back
Changes in the surface of a mole, such as oozing, scaliness, bleeding, or the appearance of a lump or bump

Point out anything you’re concerned about to your dermatologist!

If you do develop skin cancer, your dermatologist may use a special pain-free procedure to completely remove the cancer. This is called a Mohs surgery and is a common procedure in transplant recipients.

Check for basal cell cancer

Basal cell cancer usually happens on parts of our bodies that get the most sun, such as your face, head, and neck. But it can show up anywhere.

What to look for:

Flat, firm, pale or yellow areas, like a scar
Raised reddish patches that might be itchy
Small translucent, shiny, pearly bumps that are pink or red and which might have blue, brown, or black areas
Pink growths with raised edges and a lower area in their center, which might have blood vessels spreading out like the spokes of a wheel
Open sores (that may have oozing or crusted areas) and which don’t heal, or heal and then come back

Check for squamous cell

Squamous cell cancer usually happens on parts of our bodies that get the most sun, such as the face, head, and neck. But it can show up anywhere.

What to look for:

Rough or scaly red patches, which might crust or bleed
Raised growths or lumps, sometimes with a lower area in the center
Open sores (that may have oozing or crusted areas) and which don’t heal, or heal and then come back
Wart-like growths

Check for melanoma using the ABCDE method

Melanoma is the deadliest type of skin cancer. Use the “ABCDEs” to check your spots and moles for signs of melanoma:

Asymmetry: One part of a mole or birthmark doesn’t match the other.
Border: The edges are irregular, ragged, notched, or blurred.
Color: The color is not the same all over and may include shades of brown or black, sometimes with patches of pink, red, white, or blue.
Diameter: The spot is larger than ¼ inch across – about the size of a pencil eraser – although melanomas can sometimes be smaller than this.
Evolving: The mole is changing in size, shape, or color.