Back to the Basics: Sun Safety to Minimize GVHD

By Elaine S. DeMeyer, RN, MSN, AOCN®, BMTCN® - Last Updated: June 7, 2022

The sun’s ultraviolet (UV) rays increase the risk of developing acute and chronic graft-versus-host disease (GVHD), even years after stem cell transplant (SCT). Everyday sun exposure, such as riding in a car, walking the dog, sitting outside, or having a picnic, can be devastating to an allogeneic SCT survivor. Patients may think that they are not at risk when they get in the car in their garage and are dropped off at the entrance to the cancer center. However, even sunshine through the car window can be enough to trigger GVHD or cause a sunburn. Tinted glass reduces UV transmission but does not entirely block UV radiation. Nurses need the facts to dispel this myth and other common misconceptions about sun protection so they can teach patients about the risks and ways to limit exposure to the sun.

What Is Slip, Slop, Slap, Seek, Slide?

The Slip, Slop, Slap, Seek, Slide campaign was developed by the Cancer Council of Australia, where melanoma has one of the highest rates in the world. Its goal was to educate young children using the “Sid the Seagull” character to change attitudes and behaviors with 5 easy steps to protect against skin cancer. Many US cancer centers also have adopted this strategy to protect against skin cancer by teaching patients about sun safety. In addition, transplant center nurses are now receiving education on using this slogan as part of their survivorship care plan.

  • Slip on Protective Clothing. Survivors need to wear protective clothing such as long sleeves, pants, or UV protective apparel with built-in SPF. Educate patients to look for clothing with ratings of UPF 50 or higher, which block 98% of UVA/UVB rays. Ideally, patients would continue to use sunscreen with UV protective clothing as an extra layer of protection.
  • Slop on Sunscreen. A sunscreen with SPF 50 or higher is recommended by Be the Match for transplant patients. Encourage them to apply sunscreen 15-30 minutes before going outside and reapply every 2 hours. Most survivors forget the importance of frequent additional applications of sunscreen, which is especially critical after sweating, swimming, or towel drying.
  • Slap on a Hat. Help patients select a hat with a broad brim to shield the face and ears. Unfortunately, baseball caps do not provide protection for the ears or offer enough shade over the face.
  • Seek Shade. The sun rays are significantly damaging between 10 am and 2 pm. If the sun cannot be avoided, patients can use an umbrella.
  • Slide on the Sunglasses. Encourage patients to look for 100% UV protective eyewear. Eye protection may be helpful for patients with chronic ocular GVHD or dryness due to the wind and helps prevent early cataracts.

What Are the 3 Common Myths About Sun Protection?

  1. You do not need to wear sunscreen on a cloudy, overcast day.

False. Be sure to educate patients that it is essential to use sunscreen even on cloudy days. Sun damage is from the ultraviolet radiation, not the temperature outside. Since UV radiation can penetrate some clouds, damage can occur without the sun, especially in patients with sensitive skin after SCT. Remind patients that the sun is just as harmful on a cool, overcast day as it is on a hot, bright day.

  1. Sunscreen is not necessary if makeup has SPF in the product.


False. Transplant patients require cosmetics to have an SPF 50 or higher, but most products are lower than this recommendation. Be sure to educate patients to apply separate sunscreen underneath their makeup and reapply every 2 hours, not just in the morning.

  1. You can stay out longer if you are wearing SPF 50+. 

False. Although “SPF 50+” sounds like a high level, it does not completely block all UV radiation. A sunscreen with SPF 50 or higher filters 98% of UV radiation, and even that tiny percentage of UV rays can damage the skin.

Avoiding sun exposure needs to be a lifelong habit for all people and especially SCT survivors. In addition to triggering or aggravating GVHD, the risk for aggressive skin cancers as a secondary cancer is higher in patients who experience chronic GVHD. Therefore, with improved long-term survival of SCT patients, particularly pediatric patients, nurses need to improve education and counseling about sun safety and routine dermatologic screening.


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Summer Safety: Take Steps to Take Care of Yourself

Aggressive Skin Cancers in Patients Who Experienced Chronic GvHD After Allogeneic Bone Marrow Transplantation