Skin Care After Childhood Cancer

Cancer treatment during childhood can increase your risk for skin cancer and other skin issues. It is important to know about your risk and protect your skin.

Skin Cancer Risk

Skin cancer is one of the more common cancers in young adults (regardless of prior cancer history). Skincare and protection is important for all childhood cancer patients and survivors. Even people with darker skin pigment are at risk of getting skin cancer and need to protect their skin.

Radiation makes skin more sensitive and increases your risk of skin cancers. Skin cancers include:

• Melanoma: The most serious type of skin cancer. It can begin in a mole you were born with, but not always. It is important to know your own skin. You should talk to your provider if you have any changes to moles, new moles, or any new changes to your skin.
• Basal cell cancer: The most common type of skin cancer. This is often caused by sun exposure and/or radiation. It may begin as a rough patch of skin and turn into a sore or ulcer that does not heal.
• Squamous cell cancer: This type of cancer is most often related to the sun and/or radiation exposure. It often looks like a sore or ulcer that does not heal.

Risk of Other Skin Issues

Other skin issues can happen after radiation treatment and/or if you 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 and can be easily injured. There is less blood flow to the area which can cause wounds, cuts, and scrapes to heal slowly. It can help to keep your skin moisturized and avoid injury.
• Scleroderma: A type of skin fibrosis that can be anywhere on the body and is related to GVHD. Treating the GVHD can help the scleroderma.
• Telangiectasias: Also called spider veins, these are small blood vessels that become visible on the surface of the skin in the area you had radiation. They are not harmful and are not often treated.
• Changes in pigmentation (color of skin):
  • Hyperpigmentation is when the skin becomes darker. This can happen in the area where you got radiation. It can also be caused by certain types of chemotherapy and can affect the nails and skin anywhere on the body. It 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 make the skin’s color. This can be permanent. Skin that has lost its color is very sensitive to the sun and should be protected.

When should I talk to my provider?

It’s important for you to know your own skin- know your birthmarks, blemishes, and moles so you can spot any changes. Look for changes in the size, color, texture, or shape of existing moles and any new moles, marks, ulcers, or sores on your skin. If you had radiation, pay close attention to any skin that was in the field of radiation. Tell your healthcare provider about any changes you notice.

How can I protect my skin?

• Have a yearly skin exam with your primary care provider or a dermatologist. They should be sure to look at any areas that were exposed to radiation.
• Limit your exposure to the sun.
• Do not use tanning salons, lamps, or beds.
• Avoid being out in the sun during peak hours (between 10 am-4 pm).
• When you are outdoors, spend time in the shade as much as possible.
• Wear protective clothing like long-sleeved shirts, pants, a wide-brimmed hat, and sunglasses. You can also wear 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!
• Protect your eyes with sunglasses that have UV filtering. Sun damage to the eyes can lead to early cataracts.
• Wear sunscreen anytime you are outside. Choose a sunscreen that is "broad spectrum" which means 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 30 or higher even in the winter. Sunscreen use is very important for children because sunburns during childhood increase the risk of melanoma later in life.
  • Use more sunscreen than you think you need. Most adults need at least 2 tablespoons of sunscreen to get good coverage and most people do not use enough.
  • Don’t forget to protect your lips, neck, and ears with SPF. If you have thinning hair or are bald, wear a hat to protect your scalp.
  • Reapply sunscreen after swimming or sweating- no sunscreen is truly waterproof.

Caring for and protecting your skin is important after treatment for childhood cancer. Talk to your provider if you have any questions.