Background: Azathioprine and TNF-α inhibitors are widely used immunosuppressants in Inflammatory Bowel Disease (IBD). It has been reported that such treatments increase the risk of developing all types of skin cancer. Patients on combination therapy have been shown to have up to five times the relative risk of non- melanoma skin cancer. The British Association of Dermatology (BAD) has published preventative guidelines for patients on immunosuppression, but specific gastroenterology recommendations are lacking.
Our aim was to assess knowledge of skin cancer risk factors and preventative strategies in an Irish at risk IBD cohort.
Methods: A prospective pilot cohort study. Following ethical approval and informed consent, a self-assessment questionnaire was given out to patients attending our IBD clinic over a twelve week period. Clinical data was recorded including diagnosis, immunosuppressants, skin cancer risk factors and photoprotective behaviours.
Results: To date, 178 patients completed the questionnaire. Patients were excluded as follows; 21 (12%) with an unconfirmed diagnosis or indeterminate colitis and 58 (33%) not on azathioprine or TNF-α inhibitors.
Data was therefore analysed on 99 (56%) patients. Of these 52 (53%) were women, mean age 40 years (range 17–72 years). In total 78 (79%) had Crohn's disease, 21 (21%) ulcerative colitis, 59 (60%) were on anti-TNFs, 25 (25%) on azathioprine and 15 (15%) were on both.
The majority of patients were a high risk phenotype with light coloured eyes (62% n=61), fair skin (51% n=50), >30 freckles (49% n=49) or had blonde/red hair (24% n=24). Of interest, one (1%) patient had a personal history and 14 (14%) gave a family history of any type of skin cancer. With regard to other risk factors; 24 (24%) worked outdoors, 29 (29%) used sunbeds and 41 (41%) had previous blistering sunburn.
With reference to BAD recommended preventative measures, the majority of our cohort (71% n=70) wore sun cream, but failed to take other important measures; re-applying sun cream every 2 hours (46% n=46), wearing a hat (20% n=20) and staying in the shade at high risk times (54% n=53).
In addition, while 58% (n=57) knew what changes to look for in a suspicious mole, only 37% (n=37) performed regular self-skin checks.
Conclusions: Our pilot study highlights gaps in our at risk IBD cohort's education regarding skin cancer risk and prevention associated with immunosuppression therapy and warrants further investigation. Ideally educational interventions to enhance patient awareness should be undertaken and assessed.