If you are taking immunosuppressant medication, it is important that you take good care of your skin. This is because people who are immunosuppressed are at greater risk of developing skin cancer.

Why am I more at risk from skin cancer?

If you have myasthenia you will possibly be given immunosuppressive drugs. These drugs work by reducing your immune system, however, these treatments also increase your risk of skin cancer and some benign (non-cancerous) lesions and infections.

How likely am I to get skin cancer?

Everyone who takes immunosuppressive drugs is at risk of developing skin cancer and this risk increased with time. Whilst all people taking immunosuppressants are at risk, some are more likely than other to develop skin cancer. People with any of the following features 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 worker or heavy sun exposure in the past
• history of skin cancer.

There is also a higher risk if you are taking more than one immunosuppressant drug.

If you are of African, Arab, Asian or Oriental descent you are less likely to develop skin cancers (particularly those which are related to sunlight exposure).

How can I spot signs of skin cancer?

Skin cancer is much easier to treat if it is detected early. Check your skin all over your body for changes once a month. You may need to use a mirror to check hard to see areas, such as your back or the backs of your legs. A friend or family member could 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.

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. Pre-cancerous skin lesions, which are much more common in immunosuppressed people, are usually easily diagnosed without the need for a biopsy.

How can I reduce the risk of getting skin cancer?

Many skin cancers could be avoided by changing your lifestyle. Exposure to the sun is the main cause of skin cancer in immunosuppressed 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 time drive in the car (even with the windows closed). The sun is a problem all year round, not just in the summer.

However, you can take some simple precautions to help prevent a skin cancer from developing:

• Cover up; wear a sun hat, long sleeves and trousers in sunny weather.
• Stay in the shade, particularly between 11:00 a.m. and 3:00 p.m.
• When outdoors, use a sunscreen of Sun Protection Factor (SPF) 30 or above, and a 3- or 4-star rating that protects against both Ultraviolet A and Ultraviolet B (UVA/UVB). Re-apply the sunscreen every 2 to 3 hours and after swimming.
• Make sure you use sunscreen on the back of your hands, ears and on your feet if you are wearing open sandals.
• Remember that winter sun, such as on a skiing holiday, can contain just as much of the damaging ultra-violet light as summer sun.
• Do not use sun beds or sunlamps as these are concentrated forms of ultraviolet light A which can increase your risk of developing all types of skin cancer.
• Consider purchasing UV protective swim and beach wear. This looks like normal swimwear, but it is made from a special material which blocks the UVA and UVB rays. This can particularly help to protect your trunk (tummy, back and sides) when swimming on holiday.

Can skin cancer be cured?

Most skin cancers, if treated early, can be cured. That is why it is important to report any new marks or changes to your skin to your doctor.

Basal cell carcinomas can eb 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 in the body, but if caught early can be cured.

How can skin cancer be treated?

Skin cancer can be treated in several different ways:

• Surgery
• Curettage and cautery
• Cryotherapy
• Creams
• Photodynamic therapy
• The removal of lymph nodes
• Radiotherapy
• Chemotherapy

In some people with more serious types of skin cancer, it may be advised that their immunosuppressant medication is reduced or stopped.

Vitamin D and the skin

Vitamin D is important for maintaining healthy bones and muscles, and current research suggests it may also play a role in preventing several diseases, such as cancer and autoimmune conditions. Although humans can get vitamin D from several food sources, most of this vitamin is produced by our own skin, after exposure to UV light. The skin is able to make vitamin D long before it starts to burn.

Unfortunately, it is almost impossible to determine a safe level of sun exposure for each person that will give them adequate levels of vitamin D, without increasing their risk of developing skin cancer.

Exposing your face and forearms to sunlight during your everyday activities, without causing sunburn, should be enough. Vitamin supplements and specific foods rich in vitamin D (such as oily fish) may also help you to receive the right levels needed. If you are concerned, please speak with your GP or your hospital doctor. They will be able to arrange a blood test to check your vitamin D level and will discuss taking vitamin D supplements, if they are required.

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