Ireland is perceived as home to a population of Fitzpatrick one and two skin types. In 1997 Gibson et al examined the predominant skin type of Ireland 1 . This study found that 0% of the population had Fitzpatrick skin type six. Modern day Ireland is an evolving country with a diverse population. Objective To analyse the predominant skin type in Ireland using the patient self-reported Fitzpatrick scale, determine the association of skin type with hair and eye colour and assess sunbed usage in patients according to Fitzpatrick skin type. Methods 750 patients recruited from both dermatology clinics(79%) and general medical clinics(21%). Ethical approval was obtained and each consenting patient was given an anonymized questionnaire querying the participant demographics, phenotype, ethnicity, sun protection habits and skin cancer history. Skin type was assessed with the standard Fitzpatrick skin type questionnaire. Statistical analysis was carried out using Microsoft excel, log regression analysis. Results 750 patients were evaluated. 52.3%(n = 392) were female, 47.7%(n = 357) were male. The median age was 56 years. 83% had solely Irish ethnicity and 17% were of other ethnicities. The distribution of skin types was as follows: Type 1:24.4%, type 2:41.5%, type 3:23.6%, type 4:5.4%, type 5:3.1%, type 6:2.4%.Of the total population 18.8%(n = 98) used sunbeds. Skin type 2(54.8%) and 3(22.5%) used sunbeds most often. Of the 750 patients 14.8% had a previous skin cancer with 43.1%:BCC, 46.5%:SCC, 10.2%:melanoma. Within the skin cancer group 9.4% had used sunbeds,72.9% wore sunscreen and 54.7% were on immunosuppression Discussion Ireland has become a diverse and multi-cultural island, with 20.8% of people being of non-Irish ethnicity. Health professionals need to be aware of this as this population may need language translators. There are more patients with skin of colour also. This means more education needs to be provided to medical professionals to allow accurate diagnosis, referral and treatment of this population.

Skin cancer is the most common form of cancer in the UK and Ireland, with the number of skin cancers expected to increase further by 2038–2040. Conspiracy theories surrounding sunscreen use are becoming rampant across social media platforms. We aimed to further investigate the misinformation and conspiracy theories surrounding sunscreen use on TikTok by performing a cross-sectional analysis of relevant TikTok content. This analysis highlighted the presence of an alarming amount of sunscreen misinformation on the popular social media platform.

Skin cancer is the most common cancer in the UK and Ireland, with the number of non-melanoma and melanoma skin cancer diagnoses in the UK expected to rise by 39% [1] and 9% [2] by 2040, respectively. The World Health Organisation (WHO) advocates for the use of photoprotective clothing including wide-brimmed hats, tightly woven clothing, and wraparound style sunglasses that provide 100% ultraviolet-A (UV-A) and ultraviolet-B (UV-B) protection to combat the deleterious effects of UV radiation and increasing skin cancer rates [3]. The photoprotective standard of clothing is often measured as the ultraviolet photoprotective factor (UPF). UPF measures skin erythema at various UV radiation doses, and is analogous to the SPF of sunscreen [4]. UPF is defined as the ratio of the average effective UV irradiance calculated for unprotected skin, to the average effective UV irradiance calculated for skin protected by a given fabric [5]. The European Committee for Standardisation (CEN) has developed a standard on requirements for test methods and labelling of sun-protective garments. UV protective clothing for which compliance with this standard is claimed must have a UPF of greater than 40 (UPF 40+) and must maintain an average UVA transmittance of less than 5% [6]. We aimed to investigate the frequency of UPF-rated photoprotective clothing sold online by the United Kingdom's largest retailers. The UK's top 30 retailers based on annual revenue generated were identified for the year 2023–2024 [7]. Each online retailer's website was searched for "UPF clothing" and "UPF" between September and December 2024 (Table 1). Seven online retailers were excluded as they did not sell clothing; the remaining 23 retailers were included for analysis in this study. Of the 23 remaining stores, 35% (8/23) sold UPF-rated clothing online. Three retailers sold UV protective clothing for men, women, and children, while this photoprotective clothing was less widely available on the remaining 5 retailer's online catalogues. Of the stores that did have UPF-rated clothing, 50% (4/8) had fewer than 15 UPF-graded items for sale; 25% (2/8) had over 200 UPF-graded items on their website. All UPF-rated clothing identified from these retailers websites were rated UPF 40+ or above, thereby complying with the CEN's guidance on UV protective clothing. The stores that had a selection of UPF-rated clothing on their website included Amazon, H&M, John Lewis, JD Sports, NEXT, House of Fraser, Screwfix and Very. The vast majority of UPF rated clothing identified were activewear and children's swimwear; there was a scarcity of "every day" casual clothing with a UPF rating. Our online search of UPF-rated garments revealed that this photoprotective clothing is not readily available, with only 35% of the UK's largest online retailers stocking UPF-rated clothing. The poor availability of UPF-graded clothing may be partially attributed to the time of year in which we conducted our online search, months of the year that typically receive less sunshine. Furthermore, UPF-rated clothing may incur extra production costs that limit its availability; the cost of UPF testing, the cost of photoprotective fabrics, and costs associated with quality control measures in the production of photoprotective fabrics [8]. Prior head-to-head studies of UV protective clothing to sunscreen have indicated that clothing should be considered the cornerstone of UV protection [9]. Public health campaigns may provide a potential solution to target this public health concern, placing emphasis on UPF-rated clothing as an essential photoprotective measure. Furthermore, a role also exists for government intervention where the promotion of photoprotective practices and skin cancer prevention is concerned, a role which has already been realised in both the UK and Ireland with the implementation of a Skin Cancer Prevention Strategy and Action Plan (2011–21) by the Department of Health, Social Services, and Public Safety in Northern Ireland, and a Skin Cancer Prevention Plan by the National Cancer Control Programme (NCCP) in Ireland [10, 11]. Nicola Kearney: conceptualisation, methods, writing–original draft. Mary Laing: writing–review and editing subsequent drafts, supervision. The authors declare no conflicts of interest. The data that supports the findings of this study are available in Table 1 of this article.

To our knowledge, we report the first case of Trichophyton indotineae in Ireland, highlighting the pathogen’s resistance to conventional antifungal treatments and the necessity for advanced diagnostic techniques. Notably, the infection in our patient began to resolve when griseofulvin liquid was unintentionally used topically, suggesting an alternative treatment approach for this resistant dermatophyte.

Abstract Lentigo maligna (LM) can present with subclinical extension that may be difficult to define preoperatively and lead to incomplete excision and potential recurrence. Preliminary studies have used reflectance confocal microscopy (RCM) to assess LM margins. Knowing the margin prior to surgery allows for forward planning and enables the doctor to discuss the plan with the patient. The objectives of this study were (i) to evaluate the correlation of subclinical extension of LM defined by RCM compared with the gold standard of histopathology, and (ii) to assess the impact of multiple surgical excisions on a patient’s mental health and quality of life. This was a prospective study of patients with LM referred for surgery. RCM was performed at the clinically defined initial surgical scar, followed by staged RCM imaging of the ‘normal’ skin to define the exact margin of the lesion. Punch biopsies were then completed along the negative margin to ensure the accuracy of the results. Patients then completed a questionnaire detailing their knowledge of LM and the impact that multiple surgeries had on their life. Ten patients were included: five male and five female. All patients had undergone multiple surgeries without obtaining a negative margin. Ninety per cent had a facial lesion and 10% had a chest lesion. The mean largest diameter was 2.8 cm (range 0.8–5). Diagnostic accuracy for detection of residual LM using RCM was 97%. Histopathology correlation revealed that 96% of biopsies matched the RCM findings. All participants reported a negative impact on their quality of life. Eighty per cent of patients thought LM was melanoma. Fifty per cent of patients were not informed of the nonsurgical options. Twenty-five per cent of patients would not have opted for surgical excision if they had understood the extent of the surgery. In conclusion, providing optimal care for patients with LM requires a multidisciplinary approach. RCM is an useful tool to aid surgical planning and for managing patient expectations in LM.

Abstract We aimed to assess the cohort of patients attending our dermatology department who have been displaced by the war in Ukraine, to evaluate the impact of the conflict on the continuity of medical care, and to shed light on the challenges faced by political refugees in an unfamiliar medical system. Consenting Ukrainian refugees attending our department over a 3-month period answered questions regarding their displacement, medical history, and reason for referral to the dermatology service. We assessed the impact of their care on our department including translators, treatment plans and further follow-up appointments. We also present a single patient’s story, highlighting the devastating impact political conflict can have on patient care. Seventeen patients participated in the study. Most patients (82%) arrived in Ireland over 1 year ago. Thirteen of the presenting complaints (76%) occurred prior to displacement. Six patients were referred for assessment of a rash and 11 with lesions. Working diagnoses included benign naevi (35%), skin cancers (29%) and inflammatory dermatoses including eczema, psoriasis and tinea (35%). Four patients had translators booked, while the remainder communicated through family members or an online translator service. In total, seven patients required excisions, two required systemic treatment and one required biologic treatment. The remaining 10 patients were discharged from dermatology. We also present a single patient’s story. The patient was a 46-year-old woman referred to dermatology with psoriasis for which she was previously on maintenance treatment with methotrexate in Ukraine. She incidentally had a lesion recently excised in Ukraine, from which she never got the results due to the war. Following her displacement she subsequently developed pain and swelling around her surgical site. Investigation revealed what was likely metastatic melanoma. Political conflict can lead to fractured patient care, catastrophic outcomes and increased pressure on thinly stretched healthcare resources. Our hospital’s immediate catchment area has accommodated just under 10 000 Ukrainian refugees to date and we have seen some of the deleterious effects this conflict has had on patient care as a consequence. Nevertheless, we must continue supporting political refugees to the best of our ability, keeping in mind the impact of displacement on their care.

Abstract Background Renal transplant recipients (RTRs) experience cutaneous symptoms, some due to immunosuppressive medications, which can affect their quality of life (QOL). Previous studies noted a higher impact on QOL of younger female recipients. Objectives We sought to examine current trends in dermatology QOL in Irish RTRs. Methods Dermatology life quality index (DLQI) and dermatology conditions, past and present, were analysed in a cohort of RTRs in a single centre in the West of Ireland. Medical records were cross referenced. Results Sixty‐six RTRs participated, 70% male with a mean age 55 years ± SD13.6. Most participants (80%) described the presence of a skin condition. Despite this, many (71%) reported ‘no effect’ on their quality of life. Skin cancer, experienced by 26%, was associated with a small but significant effect on QOL. Biopsy proven actinic keratoses, on the other hand, was not. Cutaneous infections (bacterial and fungal) of the lower limb had the largest effect on QOL. Although not significant, male RTRs were more likely to report skin issues when asked and less likely to have seen dermatology for them. Unlike previous studies age or gender did not significant effect on QOL. Conclusions The findings of our study demonstrate a shift in trends of cutaneous complications of RTRs and highlights a need to consider foot care in this patient population. We illustrate a difference in health seeking behaviour of RTRs of different genders and a need for a focussed proactive skin cancer surveillance programme that targets not only early detection but also prevention in male organ recipients.

Human Papillomavirus is a highly contagious, double-stranded DNA virus found in humans. There are over 200 known types of HPV and it is associated with mucocutaneous, sexually-transmitted and malignant conditions. Many such conditions are regularly seen and managed by dermatologists using a variety of destructive treatments including CO2 laser, electrocautery and cryotherapy. Generally, lesions that are suitable for such treatments are induced by HPV genotypes that are considered lower risk for causing malignancy. However, both high and low-risk HPV genotypes have been shown to co-exist within benign lesions.1, 2 Skin-to-skin contact is a known method of HPV transmission and proper use of gloves effectively eliminates this risk. However, there is growing evidence to suggest that aerosolizing and smoke-plume-forming procedures regularly employed by dermatologists in the treatment of HPV lesions, may confer a risk of virus transmission to the healthcare worker. Despite this risk, HPV vaccination is not currently offered to dermatologists in Ireland or the UK. A national survey of dermatologists, dermatology trainees, nurses and GPs was completed. We aimed to assess the understanding of and concern regarding the risk of HPV transmission among the Irish dermatology community. Seventy-five people completed the survey. 78.1% were female, 21.8% were male. The job title breakdown is shown in Figure 1a. Only 36.8% of participants were aware of the risk of contracting HPV infection through aerosolizing/smoke-plume-generating procedures such as cryotherapy, electrocautery and CO2 lasers. Ninety-three per cent of participants regularly perform these procedures. The use of N95 masks and extraction systems has been recommended by the BAD during aerosolizing/plume-generating procedures, however, 94.5% of people surveyed do not wear a mask when performing these procedures. Similarly, 79.5% of people surveyed do not have access to an extraction/ventilation system. Overall, 76.8% of people surveyed were concerned about the possibility of occupational HPV transmission. Seventy-six per cent of participants were not vaccinated against HPV. Of the remaining 23% who were vaccinated, one third received it through the cervical cancer vaccination programme. The remainder sought out the vaccine themselves for prevention of other malignancies (73%) and secondary to work exposure risk (27%). Nearly all (97.2%) participants would avail of the vaccine if it were offered to them. HPV has been isolated from swabs of the nasal mucosa of healthcare workers performing smoke-generating procedures on HPV-associated lesions.3 Bovine cutaneous fibropapillomas removed from cows were exposed to CO2 laser at various settings. The smoke was collected and re-inoculated onto the skin of calves. New lesions were then demonstrated at the site.4 As well as these experimental models, there are a number of case reports that describe HPV-associated disease in at-risk healthcare workers.5, 6 In 2020 the ASCCP began recommending the HPV vaccine for gynaecologists performing excision or ablation of HPV-associated lesions.7 There are few risks associated with the vaccine, with injection-site pain being the main side effect.8 The BAD and EADV have not yet recommended vaccination, but do call for the use of PPE and further occupational health research into the topic. Our study was designed to examine the opinions and understanding of the Irish dermatology community with regard to the occupational risk of HPV infection. It demonstrates that concern about the risk of HPV infection is growing. It also shows that the majority of these individuals would avail of the HPV vaccine if it were offered to them. Perhaps our most relevant finding was the poor compliance with PPE by individuals performing potentially infectious procedures. This, in combination with the limited availability of smoke extractors in their places of work, suggests that education and perhaps formal audit is required to improve safety standards. This article has no funding source. The authors have no conflict of interest to declare. Project completed in compliance with the ethical board. The data that supports the findings of this study are available from the corresponding author upon reasonable request.

Hats aid in reducing exposure to both direct and diffuse ultraviolet light, but hats are of mixed styles and the resultant sun-protection value is variable. Adult male patients have higher rates of skin cancer, especially of the head and neck, than other subgroups. The UK and Australia have set standards for what constitutes a sunhat, whereas no such standard exists in Ireland. We explored adult male sunhats for sale during the summer in a single urban region in the west of Ireland. All the hats available were compared with the UK standard, BS 8466:2006. Almost 90% of the hats available did not meet this standard and thus did not offer adequate sun protection. Ireland requires legislation on what constitutes a sun-hat and more availability and visibility of such hats for men to encourage the use of hats for photoprotection.

Renal transplant recipients (RTRs) are at increased risk of keratinocyte skin cancers, with a tendency to have multiple, aggressive and difficult-to-treat tumours. The eye and the skin share the same embryological ectoderm. Iris pattern has recently been reported as a predictive risk factor for skin cancer in nonimmunosuppressed Southern European and Irish populations. Our aim was to analyse whether an individual’s iris pattern is an independent risk factor for the development of keratinocyte carcinoma in RTRs. Iris patterns of 110 RTRs were evaluated using the Simionescu visual three-step technique (iris periphery, collarette and iris freckling). Established risk factors for skin cancer in patients with transplants were recorded as confounding factors. This was an observational cross-sectional study. Among the 110 RTRs, 31 participants had skin cancer. In the skin cancer group, iris periphery was blue/grey in 74% (P = 0.053, odds ratio 2.5), the collarette was light brown in 57% (P < 0.004) and iris freckles were present in 55% (P = 0.04). Dark brown and blue collarettes were observed in controls. Binary logistic regression analysis showed that light brown collarette is a significant independent risk factor for skin cancer (odds ratio 4.54, confidence interval 1.56–10.6, P = 0.02). Within this RTR population a blue iris periphery, light brown collarette and presence of freckling confer an independent risk for skin cancer. Iris pattern is a useful tool for identification of transplant patients at risk of skin cancer and an easy-to-use technique for risk evaluation in this cohort. This is the first study to investigate iris pattern and skin cancer risk in RTRs.

Case report of Morphoea induced by the use of electronic cigarettes.

In July 2022, NICE published an updated guideline on the staging and surveillance of melanoma, which significantly increased the burden of imaging required.1 Increased imaging aims to identify low-volume recurrent disease quickly to allow prompt treatment and improve survival. However, this comes at a cost of increased radiation exposure, patient anxiety, financial strain and increased pressure on stretched clinical resources.2 Guidelines exist to guide clinicians to improve clinical outcomes. However, guidelines have limitations and the patient may not be the sole priority.3 Guidelines can be influenced by the guideline development group and can be steered in one direction based on current scientific evidence, which may be lacking. The patient may not be the sole priority as cost and societal need are considered when making the guideline. Guidelines may also try to protect special interest groups through distributive justice. Guidelines can also lead to escalated utilisation of a specific modality, in this case computed tomography (CT) scans, which can compromise operating efficacy and may increase the requirement of already limited resources.3 CT scans cost less than other imaging modalities. A CT-Thorax, Abdomen and Pelvis (CT-TAP) costs 161.19€ with contrast, whereas a positron emission tomography-CT costs 1691€ and a magnetic resonance imaging (MRI) 295€. The recommendation of CT scans was most likely cost based, as MRI scans are more costly. When looking at the Australian 2016 guideline, the melanoma focus guideline and the European consensus 2019 guideline, CT-TAP is employed but with a broader imaging schedule as per the treating physician's guidance, this is usually in conjunction with an MRI brain. CT-TAP is an effective and cost-efficient imaging modality. MRI -TAP would be unrealistic cost-wise as an MRI costs 295€ per body area. However, NICE 2015 did advocate whole-body MRI for children and adults under the age of 24 with stage III or suspected stage IV disease. Most other guidelines do not recommend CT-Brain, opting for MRI brain instead. After obtaining ethical approval, 220 patients diagnosed with melanoma between January and July 2022 were reviewed. Imaging costs were obtained from the hospital's financial and business managers and the quantity of radiation exposure was estimated based on Food and Drug Administration figures4 and reports from the melanoma focus group 2022.5 The mean age at diagnosis was 63.3 years. Patients were categorised into stages based on the American Joint Committee on Cancer, of which 23% (n = 50) were stage 0, 22% (n = 48) were stage IA, 15% (n = 32) were IB, 6% (n = 13) IC, 9% (n = 19) IIA, 8% (n = 17) IIB, 6% (n = 14) IIC, 1% (n = 3) IIIA, 2% (n = 4) IIIC and 9% (n = 20) stage IV. For our cohort of stage IIB and stage IIC without sentinel lymph node biopsy (SLNB), the cost of imaging has increased from 0€ to 1290€ per patient per year. There were four of these patients. Two patients personally chose not to undergo SLNB and opted for imaging instead at the consent stage. The reasoning behind this is that the patients themselves felt imaging was required to fully assess the melanoma as even if their SLNB was negative, in 3%–4% of patients the melanoma will come back in a different lymph node.6 One patient was pregnant and therefore did not get an SLNB, but underwent an ultrasound instead. For one patient, the reason for no SLNB was undocumented. For our cohort of stage IIIA–C not on adjuvant therapy, the cost of imaging has increased by 300% (295–899€) per patient per year. For our cohort of stage IIID–resected stage IV, the cost of imaging has increased by 728% (295–2150€) per patient per year. For our total cohort of patients, this represents an overall increased cost of 65,025€ per 1 year of staging and surveillance and 275,885€ per 5 years of surveillance (Figure 1). Stage IIB–IIIC patients would attend radiology for eight CT-TAPS and eight CT-Brains over 5 years. For our cohort, this would add up to 304 radiology appointments over 5 years. Patients who have received a melanoma diagnosis are understandably anxious when it comes to scan results. Therefore, many of them prefer to get the result in person rather than virtually via a telephone call. This adds another 304 general dermatology or plastic surgery clinic appointments. Our cohort of stage IIID–IV patients would require 340 extra radiology appointments and would require general clinic appointments to explain their results. Given the prognosis of this cohort, they would be most likely to attend an oncology clinic than a dermatology clinic, but the clinic burden would not be viable for any service. Measuring radiation dose is complex and a number of different parameters are available to quantify both radiation exposure and absorbed radiation. A CT-TAP is equivalent to 4.6 years of natural background radiation exposure (CT-Abdomen Pelvis is equivalent to 2.6 years and a CT-Thorax is equivalent to 2 years), and a CT-Brain is equivalent to 7 months (Table 1).7, 8 A stage IV patient receiving approximately 17 CT-TAPs and 17 CT-Brains over 5 years would amount to a 1.5% increased risk over the lifetime of a 40–49-year-old patient in normal health.9 Given the estimated prognosis of this cohort, the benefit of imaging outweighs the risk as previous studies have shown that patients with a lower life expectancy of 10 years are at significantly less risk of developing radiation-induced cancer from medical imaging.10 Stage IIB patients traditionally underwent a wide local excision and an SLNB, and if this was negative, they did not receive further imaging. This cohort has a 98.4% 5-year survival at baseline, and under the new NICE 2022 imaging guideline, it would now undergo an additional eight CT-TAP and CT-Brain studies over the 5 years. The majority of our stage IIB patients were less than 40 years of age. The question must be asked, does the risk of repeated CT imaging outweigh the risk of radiation-induced secondary carcinoma? A 10-year prospective analysis11 of 290 patients with stage IIB, IIC and III Cutaneous Melanoma assessed the detection rates of imaging with CT of the chest/abdomen/pelvis and brain MRI every 6 months for 5 years after diagnosis, followed by annual chest radiography until year 10. Nearly 40% of patients developed metastasis at a median of 1.4 years. Imaging detected 56.7% of recurrences (mainly visceral), as compared with 41.5% of recurrences initially detected by patient or provider examination. Most clinically detected recurrences were cutaneous. Overall survival was not assessed, however, preventing conclusions as to the merit of this intensive imaging approach in terms of patient outcomes. This study did not account for the advances in melanoma treatment with immunotherapy. As the treatments have advanced and improved, so has overall survival; therefore, further evaluation of radiological monitoring frequency and requirement needs to be completed with this in mind. In conclusion, the aim of imaging surveillance remains the same as before, to identify and treat patients with low-volume recurrent disease earlier to maximise the benefit of treatment and improve survival while balancing this against the risks of radiation exposure, patient anxiety and increased pressure on already stretched clinical resources. M. Leahy: Data curation, methodology, software, writing—original draft preparation. B. Byrne: Conceptualization, writing—reviewing and editing. R. Durganauda: Writing—reviewing and editing. J. NiMhuircheartaigh: Supervision, writing—reviewing and editing. M. Laing: Supervision, writing—reviewing and editing. The authors declare no conflict of interest. Full ethical approval was obtained prior to commencement of this project. Data are available on request from the authors.

Abstract Background Hidradenitis Suppurativa (HS) is a chronic, relapsing, inflammatory skin condition which is physically, psychologically and socially disabling and often affects a patient's quality of life (QOL). There are numerous QOL tools used in dermatology. However, assessment of QOL in patients with HS is difficult due to the inability of generic QOL tools to specifically capture QOL in patients with HS. Numerous HS‐specific QOL tools have been developed in recent years. It is important to identify evidence on full psychometric evaluation of these tools. Objectives There has been a gradual increase in the use of generic and disease‐specific QOL tools in the last few decades. The aim of this scoping review (SR) is to evaluate the most widely used generic QOL tools and HS‐specific QOL tools to identify the psychometric evaluation of such tools. Methods Design: An SR guided by Joanna Briggs Institute manual and Arskey O’Malley framework guidelines. Data extraction included the studies available on full psychometric evaluation of the most widely used dermatology generic QOL tools in HS and HS‐specific QOL tools. Results Ten papers were included in the review, eight papers demonstrated HS‐specific QOL assessment tools. The psychometric properties of these tools were underpinned by reliability, validity and sensitivity measurement. Six disease‐specific tools were identified in this SR. However, they all lack full psychometric evaluation. Conclusion This review indicates that an extensive research in the field of QOL tools for HS is much needed. It is crucial to develop user‐friendly and validate disease‐specific tools to measure the real impact of disease on patients QOL. QOL instruments can evaluate the impact on life of an HS patient, thus helping improve intervention and management of disease. There is a necessity for more research into existing HS‐specific QOL tools and they should be widely tested and fully validated.

The data in this paper are available on reasonable request from the author.

Our qualitative study of the skin cancer information delivered to renal transplant recipients (RTRs) highlighted that we must find the optimum time when things are settled for patients to absorb this information. Knowing and trusting the person delivering the information was welcomed by participants and more likely to influence behaviour, as was the healthcare professional who took time to consider the individuality of recipients. Knowledge gaps have been uncovered and require consideration, including a predominant concern of melanoma rather than squamous cell carcinoma, and a reliance on sunscreen and not other sun protective measures. Renal colleagues are highly considered by RTRs and well placed to deliver interventions

Renal transplant recipients (RTRs) are at an increased risk of skin cancer (SC), especially squamous cell carcinoma (SCC). As the number of successful transplant recipients increases, pressure on dermatology services increases. The focus has shifted from simply screening RTRs for SC to implementing preventive measures, including SP education programmes. Sun exposure is a modifiable risk, yet RTRs are known to adopt sun-protective (SP) behaviour only partially. There is a dearth of research on why this is. We performed an in-depth qualitative study using inductive thematic analysis of 14 semistructured interviews of seven male RTRs to assess the impact of the current SP education and explore their current SP behaviour. Participants included those with SC, premalignant skin disease and no SC. Two themes were constructed. Each theme had two subthemes. The first theme was ‘Timing it Right—Skin cancer information’, with the subthemes of ‘A time of great emotion’ and ‘Providing knowledge—learning needs differ’. Choosing a suitable time to impart information on SC is important. Immediately prior to and on receiving a kidney transplant was not felt by patients to be the most appropriate time. Most felt unable to consider perceived future risks to their health during this critical period. When delivered, recipients expressed preference for an ‘in-person’ approach with supplementary information available (online and written). The second theme was ‘The person within the patient’, with the subthemes of ‘What matters to the patient’ and ‘Authentic engagement’. It is important to see the person within the patient. Each brought with them different worries and requirements, sometimes feeling guilty when expressing them as they had received a new ‘gift of life’. Participants knew what constituted a good health education experience for them. The healthcare professional who was compassionate and listened was valued and more likely to influence behaviour. Interviewees spoke about the strong bond they form with their renal teams and how they trust them. Misconceptions were also uncovered such as the belief that the Irish sun differed from that experienced abroad and that SP was just for ‘sunny days’. An overriding concern for developing melanoma rather than cutaneous SCC was evident, as was the lack of confidence in ability to self-monitor skin. SC prevention programmes are becoming increasingly well established; our study identified gaps in the knowledge of RTRs and highlighted some key areas and approaches to improve the impact of educational interventions. To maximize the impact, it is important to consider patient perspectives, cultural context and the key role our renal colleagues play in patients’ lives. Funding: support was received from The City of Dublin Skin and Cancer Hospital Charity (registered Charity Number: 20004620).