Skin Cancer Prevention

Skin cancer is the most common malignancy after solid organ transplantation in adults.  Sun exposure is only risk factor you can control.  Strategies to protect yourself from ultraviolet light include sun avoidance, sun-protective clothing, and sunscreen.

Ultraviolet Light

Sunlight is grouped into 3 types of ultraviolet light; Ultraviolet-A (UVA), Ultraviolet-B (UVB), and Ultraviolet-C (UVC), based on the wavelength of the light being emitted. UVC is absorbed by the ozone, but UVA and UVB pass to the earth's surface and, therefore, are of main concern to us.

UVC radiation has a wavelength of 200-290 nanometers. This wavelength is the most harmful to the skin, so fortunately it is filtered by ozone in the atmosphere. UVB radiation (290-320 nanometers) is the wavelength that is most strongly associated with skin cancer formation. UVA radiation (320-400nm) is the range used for tanning. It is important to remember that there is variation in the biologic effects of different wavelengths within each of these subdivisions.

The amount of ultraviolet radiation that penetrates the skin is largely related to the amount of melanin within the epidermis, but is also dependent on the thickness of the skin and wavelength of the ultraviolet light. Ultraviolet-A radiation penetrates more deeply than UVB radiation.

The photobiologic effects and damage of wavelengths longer than 320nm are thought to be less than that of shorter wavelengths. However, the sun emits a greater amount of radiation in the range of wavelengths greater than 320nm (as in the UVA range), increasing its potential cumulative damaging effects.

The UV Index may be checked daily.

UV INDEX
Rating	Risk	Minutes to burn	Recommended Precautions
0 - 2	Minimal	60 minutes	Sunscreen, UV sunglasses
2 - 4	Low	45 minutes	Sunscreen, UV sunglasses
4 - 6	Moderate	30 minutes	Sunscreen, UV sunglasses & Hat
6 - 10	High	15 minutes	Sunscreen, UV sunglasses, Hat & Umbrella
10 - 15	Very High	10 minutes	Sunscreen, UV sunglasses, Hat, Umbrella & Avoiding mid-day sun

Skin Cancer Prevention and Early Detection

You have the ability to decrease your risk for skin cancer and detect skin cancers before they are dangerous. Here are three simple steps to decrease your skin cancer risk:

Step #1: Daily Sun Protection

• Use broad spectrum sunscreen daily with SPF of 30 or greater. See Sunscreen Facts for more information.  Sunscreens are safe for individuals over 6 months of age.
• Use protective clothing. This is defined as broad-brimmed hats, long-sleeved shirts with a conservative neckline and long pants. Clothing such as this is usually considered by many as very hot, and thus not worn. However, this doesn't have to be the case. Loose, light-weight fabrics can be worn that are protective and stylish. Sun-protective clothing will have a UPF (Ultraviolet Protection Factor) rating.  A rating of 40 or higher offers very good protection, blocking more than 97% of UV rays. UPF 40 or higher rated clothes are most effective, however other clothing can provide some protection as long as it is worn. The one exception to this may be a white cotton T-shirt, worn by many during the warm seasons, which provides a UPF of only ~5.
• Wear a broad-brimmed hat. Baseball style caps provide no protection for the ears, which is a common area for skin cancer to occur.
• Avoid sun exposure as much as possible between the hours of 10AM and 4PM. Attempt to concentrate outdoor activities into early morning, late afternoon, and evening. If your shadow is shorter than you are, you're likely to sunburn.
• Use extra caution near water, snow, and sand, which reflect damaging sunrays and increase your chance of sunburn.
• Avoid tanning beds. A tan obtained in a tanning bed does NOT provide protection from harmful sunrays.
• Wear sunglasses.
• Seek shade.
• Don't stay in the sun for prolonged periods of time, even if you are wearing sunscreen.

Step #2: Monthly Self Skin Examination

In a brightly lit room, with two mirrors, look over your entire skin surface. Do this once a month. A family member may assist with examination of the back, but if they are not consistently available, you can use two mirrors for this exam. Visit the American Academy of Dermatology to learn more about self skin exams.

Step #3: Timely Skin Examination by a Dermatologist

If you have any skin concerns, bring them to your transplant team’s attention immediately. They can evaluate or refer you to a dermatologist for an examination. Even people without any skin problems should be referred to a dermatologist for a skin cancer screening by a head to toe examination.

Your transplant team may recommend a routine skin screening, or you can request a referral. Depending on your individual risk factors for skin cancer and the amount of skin disease and sun damage that you have, skin cancer screening can be before transplant, immediately afterwards, or in the next few years.  Visit our About Skin Cancer page to learn about your risk for skin cancer and screening.