Inflammatory Bowel Disease and Skin Cancer: An Assessment of Patient Risk Factors, Knowledge, and Skin Practices

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Introduction: Patients with inflammatory bowel disease (IBD) have an overall increased risk for skin cancer, which is more prominent among those on immunosuppression. Young age at IBD diagnosis increases the cumulative risk of developing skin cancer. The aims of this study were to assess IBD patients' knowledge of their risk factors for developing skin cancer and to identify gaps in patient education regarding skin cancer prevention. Methods: IBD patients 18 years or older were recruited via email, online sources, and by healthcare providers in GI clinics to complete an online survey via Adobe FormsCentral. Results: A total of 164 patients (mean age 43.5 years, 63% female) with IBD (67% Crohn's disease, 31% ulcerative colitis, 2% indeterminate colitis) were included. 12% (n=19) of patients had a personal history of skin cancer and 34% (n=55) had a first degree relative with skin cancer. 70% (n=114) of patients had seen a dermatologist, 51% self-referrals and 13% referred by a gastroenterologist. Patient responses to standardized questions of skin cancer prevention, awareness, knowledge, protection, and sun exposure were scored (Table 1). Skin cancer prevention, awareness, knowledge, protection, and sun exposure scores did not differ between those with or without immunomodulator use. Patients on biologic therapies had slightly better skin cancer knowledge (3.01 vs 2.87, p=0.005) but did not have better skin cancer prevention or protection scores. Scores did not differ by patient age or diagnosis. Patients with a history of skin cancer had higher protection and prevention scores (p=0.000) and those with a family history had higher protection scores (p=0.000). 62% (n=101) of patients understood that IBD increases skin cancer risk, with a significant difference in those taking immunomodulators compared to those who were not (p = 0.000).Table 1: Skin Cancer Prevention, Awareness, Knowledge, Protection, and Sun Exposure VariablesConclusion: In this study, only 13% of gastroenterologists referred patients for dermatology consultation. Luckily, IBD patients were knowledgeable about and aware of skin cancer risk factors. Despite this knowledge, the majority of IBD patients did not practice appropriate skin protection and therefore are at continued risk for developing skin cancer. In social-cognitive theory of health behavior, knowledge of risk alone is insufficient for behavior change—patients also require skills training in skin protection. This highlights a potential opportunity for health professionals to teach and reinforce skin cancer prevention in IBD.