GD02 Understanding risk factors to strengthen skin cancer surveillance programmes for people with albinism in East Africa

Abstract

People with albinism face a heightened risk of malignant and premalignant skin lesions due to lack of melanin. The Skin Cancer Prevention Programme (SCPP) is a network of dermatology clinics providing health education, sun protection and specialized skin care to over 13 500 people with albinism in Tanzania (10 000) and Malawi (3500). The programme has been running for over 10 years, and now operates at 306 clinics across the region. The SCPP uses a clinical data platform (CommCare) to record detailed socio­economic and clinical information for all registered participants. Currently, only patients with previous skin malignancy are flagged as being at high risk; however, analysis of these data has identified other key risk factors for skin cancer. The first factor is age. Risk increases sharply in people aged > 30 years, reflecting cumulative ultraviolet damage. While tumours are less common in children aged < 16 years, this group benefits most from age-appropriate prevention messaging to build lifelong sun-­protection habits and ensure they can access support at school. The second factor is occupation. Farmers, street vendors and others exposed to intense daily sunlight are significantly more likely to develop skin cancer. Socioeconomic status is the third factor. Lower-income people with albinism often lack adequate protective clothing and access to sun cream, heightening vulnerability. The fourth factor is presence of lentigines. People with albinism without lentigines are 3.5 times more likely to develop squamous cell carcinoma and three times more likely to develop basal cell carcinoma than those with lentigines. With this information we will further define and enhance the criteria used to flag high-risk patients to doctors in clinics. Preventive education will also be adapted, with high-risk patients receiving more targeted messaging and counselling, while lower-risk groups avoid unnecessary lengthy screenings. This approach improves early detection, strengthens preventive education and ensures the most effective use of limited dermatology resources in low-resource settings, ultimately reducing the burden of skin cancer among people with albinism.