Knowledge and Risk Perception Regarding Skin Cancer in Immunosuppressed Patients: A Systematic Review and Meta-Analysis

Immunosuppressed patients have a substantially increased risk for developing skin cancer. Therefore, it is mandatory that such patients are adequately informed and aware of skin cancer and their increased risk to modify their behavior. Numerous studies have evaluated the topic, but no synthesis of their findings exists. The protocol of this systematic review was registered on PROSPERO (CRD42024618851) and its reporting followed the PRISMA-2020 guideline. To identify all studies assessing knowledge or perception of skin cancer in immunosuppressed patients, forward and backward citation tracking was employed in addition to an electronic literature search across five databases. For the risk of bias (ROB) assessment, the Joanna Briggs Institute checklist for prevalence studies was used. Quantitatively comparable outcomes were meta-analyzed, while all others were qualitatively synthesized. Thirty-two reports comprising 4214 patients were included. Acknowledging substantial heterogeneity between studies, just over two thirds of patients recalled having been informed about their increased skin cancer risk (pooled proportion: 68.34%, 95% confidence interval (CI): 55.48–78.90). Awareness of the increased risk for skin cancer varied widely (34.5–100%), and pooled mean Skin Cancer and Sun Knowledge scores were 14.77 (CI = 8.57–20.96). About half of those patients asked about risk factors for skin cancer knew that immunosuppression was among them. This indicates that immunosuppressed patients are insufficiently educated about their increased skin cancer risk. However, the high heterogeneity in the synthesized outcomes and the minimal proportion (3%) of low ROB ratings for the included studies call for further research to better understand the awareness of skin cancer risk in this vulnerable population.