In this blog post, I wanted to discuss why immunosuppressed patients are at a higher risk of developing skin cancer. Just this year, I was diagnosed with Basal Cell Carcinoma. Living with lupus, I know there is an increased risk of certain cancers, but the diagnosis still came as a surprise. It started with a small clear, pearly bump on my face just under my nose. At first, I figured it was a wart that would eventually disappear. After about four months, I started to get concerned, so I asked my doctor for a referral to a dermatologist. As with any medical scheduling, it took over a month to get me in for the exam. I was asked various questions, and I started feeling like it was a mistake that I was in there for such a little bump on my face. Once the doctor looked at my bump, he decided we should do a biopsy. He reassured me, saying he didn’t think I would end up testing positive for cancer.
A week later, I received a call saying the biopsy tested positive for basal cell carcinoma. I received the call while working, and suddenly I could no longer concentrate. Basal cell carcinoma is the best-case scenario, but I couldn’t help but feel defeated. Adding another diagnosis to my long list of medical issues was not something I intended to do at age 29. Once I could process my new diagnosis, I immediately called my husband and mother. They were both shocked, and you could tell the news was unexpected. No one wants to hear the ‘C’ word, even if it’s treatable cancer.
Enough about me. Let’s learn why immunosuppressed patients are at a higher risk for developing cancer. 
WHO IS CONSIDERED IMMUNOSUPPRESSED?
There are many reasons why an individual is immunosuppressed. In some cases, it is directly due to their disease or condition, or they can be immunosuppressed from a medication used to treat it. Below are some examples of persons who may be immunosuppressed.
- HIV/AIDS patients
- Cancer patients
- Transplant patients
- Individuals taking immunosuppressive drugs
- Inherited immune diseases
WHY DOES IMMUNOSUPPRESSION INCREASE YOUR RISK OF CANCER?
When an individual is put on immunosuppressive drugs or lives with a condition that affects the immune system, their body is less able to fight off infections and destroy cancer cells. In healthy individuals, the immune system has a fighting chance and can recognize and remove any cancer cells.
In my case, I was on Cellcept at the time, but I switched over to Azathioprine recently. Both of these medications are used for organ transplant patients, and they are used to treat rheumatic diseases as well. Azathioprine inhibits the immune system, and although it can help decrease disease activity in lupus, it also reduces the immune system’s ability to repair UV-induced cellular damage.
WHAT ARE MY CHANCES OF DEVELOPING SKIN CANCER?
Plain and simple, immunosuppressed people are at an increased risk of skin cancer. Your genetics and features will also play a role. Below are some common skin cancer risk factors, according to the CDC.
- A lighter natural skin color.
- Skin that burns, freckles, reddens easily, or becomes painful in the sun.
- Blue or green eyes.
- Blond or red hair.
- Certain types and a large number of moles.
- A family history of skin cancer.
- A personal history of skin cancer.
- Older age.
HOW CAN I PROTECT MYSELF FROM DEVELOPING SKIN CANCER?
In a previous blog, Photosensitivity and Lupus, I explain how you can protect yourself from the sun. Here are a few guidelines you can follow to protect yourself:
- Plan activities where you will be in the sun in the early morning and evening. The sun’s UVB rays are the strongest between 10 am and 2 pm.
- Continue using sun protection even when you are in the shade or during cloudy weather.
- A sunscreen with at least 30 SPF is recommended, but over 70 SPF is preferred. Using a “broad spectrum” sunscreen is the best as they protect against both types of damaging UV—UVA, and UVB.
- Plan to apply sunscreen daily, even if you do not plan on going outside.
- Sun-protective clothing is excellent to add a layer of protection as it is created to reflect or absorb sunlight.
Below you can find a few of my sun-protective clothing and sunscreen recommendations.
