# What Have We Learned about the Prevention of NMSC from Albino Patients from Malawi? Secondary Prevention Maintained over Time

## TL;DR

This study shows that providing photoprotective clothing and regular follow-up care significantly improves outcomes for albino patients in Malawi at high risk of skin cancer.

## Contribution

The study highlights the effectiveness of secondary prevention through local collaboration and teledermatology in managing skin cancer among albinos in rural Africa.

## Key findings

- Photoprotective clothing is more effective and sustainable than sporadic sunscreen use in rural settings.
- Secondary prevention with regular follow-up and teledermatology is crucial for treating high-risk patients with squamous cell carcinoma.
- Many patients were lost to follow-up, emphasizing the need for sustained local engagement and tracking systems.

## Abstract

Albino patients in rural Africa have a very high risk of skin cancer. We have conducted several cooperative campaigns in recent years focusing on the care of this population in a rural area of Malawi and have reached some important conclusions. Primary prevention is fundamental and, in addition to education, providing adequate clothing offers more sustainable and long-lasting photoprotection and is more effective than offering sunscreen sporadically. However, at present, secondary prevention focused on frequent follow-up and early diagnosis of treatable lesions is what really makes the difference in many patients affected by squamous cell carcinoma, who otherwise will eventually die. To achieve this, it is essential to have funding and local collaboration with a comprehensive organization prior to visits by using teledermatology and frequent campaigns of qualified health staff who, in addition, help in the training of local personnel.

Background: We have conducted cooperative campaigns focusing on albino patients in a rural area of Malawi. What have we learned? Methods: Three surgical campaigns were performed in Nkhotakota district (2019–2023). Albino clinical and tumor characteristics were collected. Results: Between 22 and 75 albinos were evaluated in each campaign (mean age < 28 years old). Most patients did not use sunscreen in a way that provided optimal photoprotection. Regarding tumors, the proportion of basal and squamous cell carcinomas ranged from 1:1 to almost 2:1. Of 156 albino patients, 34 attended more than once. However, of the 19 patients with 30 tumors operated on in 2021, only seven were assessed the following year (12 were lost to follow-up). At least 14 albinos with locally advanced tumors were evaluated. Conclusions: Distributing photoprotective clothing could be more efficient or perhaps an earlier measure of sunscreen in rural Africa as it does not require permanent repositioning. Very-high-risk patients (previous interventions with positive margins or high-risk tumors, intense actinic damage, and new tumors constantly appearing, especially those presenting SCCs) require close follow-up and treatment and represent our main target. Secondary prevention with Malawian collaboration and the use of teledermatology is essential for patient tracking, as they are able to offer curative treatments.