Sunscreen use before and after transplantation and assessment of risk factors associated with skin cancer development in renal transplant recipients

Objective: To determine the degree of compliance with sunscreen use among renal transplant recipients before and after transplantation and to determine risk factors associated with skin carcinogenesis. Design: Single-observer study with structured interview using a standardized questionnaire. Medical records and histology reports were examined for details of prior skin cancer. Cox proportional hazards regression was used for analysis of risk factors for developing skin cancer after transplantation. Setting: Patients attending Beaumont Hospital, the national renal transplantation center in Dublin, Ireland. Patients: The study population comprised 270 patients (182 male and 88 female), Main Outcome Measures: Patients' use of sunscreens before and after transplantation relative to known skin cancer risk factors and subsequent skin carcinogenesis. Results: Prior to transplantation, 68.5% of patients never applied sunscreen on a sunny day compared with 25.9% after transplantation. Patients 50 years or younger were more likely to always apply sunscreen both before and after transplantation (P=.01), as were female patients prior to transplantation (P=.02). Those patients who participated in an outdoor recreation were more likely to subsequently develop nonmelanoma skin cancer (P=.04), as were those older than 50 years (P <.001) and those with a history of 2 or more painful sunburns (P=.03). Conclusions: Transplant recipients are poorly compliant with the use of sunscreens both before and after transplantation. Compliance is poorest in those groups at higher risk of nonmelanoma skin cancer.