Skin Care After Cancer Therapy for Childhood Cancer

Skin Cancer Risk

Skin cancer is actually one of the more common cancers in young adults (regardless of prior cancer history). Skincare and protection should be considered important in all childhood cancer patients and survivors. It is important to remember that those with darker skin pigment are also at risk of getting skin cancer and need to protect their skin as well.

Radiation makes the skin more sensitive and increases the risk of developing skin cancers. Skin cancers include basal cell, squamous cell, and melanoma skin cancers. Melanoma is the most serious type of skin cancer. Things to know about these types of skin cancer include:

• Melanoma: The most serious type of skin cancer. It can begin in an existing mole, but not always. Know your own skin and report changes to existing moles or new skin changes to your healthcare provider.
• Basal cell cancer: The most common type of skin cancer. Often caused by extensive sun exposure and/or radiation. It may begin as a rough patch of skin and progress to a sore or ulcer that does not heal.
• Squamous cell cancer: It is most often related to the sun and/or radiation exposure. Typically appears as a sore or ulcer that does not heal.

Risk of Other Skin Issues

Other skin issues that can develop as a result of radiation treatment and/or people who have chronic graft versus host disease (GVHD) after a stem cell or bone marrow transplant. These include:

• Fibrosis: Skin becomes thick and stiff due to scarring. This skin can be easily injured. The blood flow to the area is poor which can cause wounds, cuts, and scrapes to heal slowly. Keep the skin moisturized and avoid injury.
• Scleroderma: A type of skin fibrosis that can be related to GVHD. This can affect skin anywhere on the body. Treating the GVHD can ultimately help the scleroderma.
• “Spider Veins”: Also called telangiectasias. These are small blood vessels that become visible on the surface of the skin in the area of radiation. They are not harmful and are not typically treated.
• Changes in pigmentation (color of skin):
  • Hyperpigmentation is a darkening of the skin. This can occur in the field of radiation. It can be caused by certain types of chemotherapy and then can affect the nails and skin anywhere on the body. This change may fade over time.
  • Vitiligo is a loss of color of the skin in patches. This can happen after an allogeneic transplant and is caused by the immune system attacking the cells that produce the skin color. This can become permanent. Skin that has lost its color is very sensitive to the sun and should be protected.

What concerns should I report to my provider?

Become familiar with your own skin- know your birthmarks, blemishes, and moles so you can spot any changes. Look for any changes in the size, color, texture, or shape of existing moles or the development of new moles, marks, ulcers, or sores on your skin. Note any changes in the texture or color of your skin. Report any changes to your healthcare provider. Pay special attention to any skin that was in the field of radiation.

How can I protect my skin?

• Yearly skin exams should be performed by a primary care provider or dermatologist, with particular attention to any areas of radiation exposure.
• Sunscreen should not be your first line of defense- think sun avoidance and limiting your skin’s exposure to the sun’s rays.
• Do not use tanning salons, lamps, or beds, as this UV exposure has proven to be particularly dangerous.
• Avoid sun exposure during peak hours, which are 10 am-4 pm. Seek out shady spots when outdoors.
• Wear protective clothing, including long-sleeved shirts, pants, a wide-brimmed hat, and sunglasses. You can choose clothing with built-in SPF or use a product to add SPF to clothes in the laundry.
• When choosing clothing, remember that a darker color and tighter weave provide more protection. An ordinary white T-shirt has an SPF of only 3!
• Don’t forget your eyes. Protect your eyes with sunglasses that have UV filtering. Sun damage to the eyes can lead to early cataracts.
• Choose a sunscreen that is "broad spectrum" meaning that it blocks both UVA and UVB rays, which can both cause damage to your skin. Use sunscreen with a sun protection factor (SPF) of 15 or greater every day (SPF of 30 or higher for children), even in the winter. Sunscreen use is especially important for children because sunburns during childhood greatly increase the risk of melanoma later in life.
• Apply sunscreen liberally. An average adult needs at least 2 tablespoons of sunscreen to get good coverage and most people do not use enough. If your bottle of sunscreen last more than a few months, you probably aren’t using enough!
• Don’t forget to protect your lips, neck, and ears with SPF, as these are common sites of skin cancer due to lack of protection. If you have thinning hair or are bald, wear a hat to protect your scalp.
• Reapply after swimming or sweating, as no sunscreen is truly waterproof.