Ultraviolet radiation manicure-related keratinocyte malignancies in a renal transplant recipient

The repeated development of malignancies and other skin lesions only on her hands caused us to review the case more circumspectly, and the absence of significant photodamage in other sun-exposed areas aroused our suspicion of an alternative aetiology. The patient, who had skin phototype 1, had reliably informed us that she had adopted effective photoprotective measures, which included avoidance of sun exposure, use of sunscreen, and wearing photoprotective clothing, since the first transplantation. Repeated exposure to UVA rays is well described in the setting of cutaneous carcinogenesis, acting via a direct DNA-damaging mechanism, to cause both photo-ageing and the development of keratinocyte malignancies.