Catholic University Catholic Hematology Hospital

Skin changes in cancer patients are frequently associated with the cancer itself and can arise at any point during the treatment journey. Although these changes typically aren't life-threatening, they can significantly affect a patient's physical comfort and emotional wellbeing, potentially reducing quality of life. In certain cases, these skin changes might impact the disease's prognosis or serve as an indicator of the patient's overall health. Therefore, it's crucial to communicate any skin concerns with your healthcare team.

Skin damage related to cancer often takes the form of ulcers, resulting from cancer growth and spread invading the skin. This is more prevalent in cases of metastatic or recurrent cancer than in primary cancer.

Chemotherapy can also lead to skin changes, as it can damage the basal cells in the outermost layer of the skin. These changes may manifest throughout the body or be localized to the site of chemotherapy injection. The degree of skin changes can vary based on the treatment method, duration, and the patient's overall disease status. Again, it's important to discuss these changes with your healthcare team.

Radiation therapy can lead to various skin changes in the treated area, including dryness, redness, swelling, itching, peeling, sensitivity, or darkening. The intensity of these reactions can vary, with higher doses of radiation typically resulting in more severe skin reactions. Skin located in areas where it naturally folds, such as the armpits, beneath the breasts, the perineum, and the creases of the hips, tend to be more sensitive to radiation, as these areas are typically warmer and moister.

Skin reactions usually start to appear in the treated area about two weeks after the beginning of treatment. At first, the skin may turn a light pink, which gradually darkens to a dusky color. The skin may also become sensitive and slightly swollen. As treatment continues, the skin may become itchy and dry, leading to dry skin peeling. Around 4 to 6 weeks after the start of treatment, the skin's outer layer may peel off, causing a moist skin peeling with a serous exudate. The healing period for these side effects usually spans 2 to 4 weeks. Hyperpigmentation, or darkening of the skin, can last longer, much like how a suntan doesn't fade quickly.

Late side effects, such as skin thinning (atrophy), dilated blood vessels (telangiectasia), fibroma, and swelling due to fibrosis of the lymph vessels (lymphedema), can occur several weeks to 2 to 3 years after treatment. Among these, lymphedema is more common when radiation therapy is combined with surgery, and is less likely with radiation therapy alone.

Patients who undergo hematopoietic stem cell transplantation may experience skin changes due to high-dose chemotherapy or total body irradiation as part of their pre-treatment process.

In addition, skin is often the first and most commonly affected organ in acute graft-versus-host disease (GVHD). Skin GVHD typically presents as an erythematous (red) maculopapular rash, often on the ears, neck, shoulders, chest, and frequently on the palms and soles. Skin lesions can sometimes come with symptoms like itching and burning, and in severe cases, can form blister-like lesions similar to third-degree burns, posing a potential threat to life.

These early post-transplant symptoms can be challenging to distinguish from reactions to various medications such as antibiotics, rashes due to viral infections, or symptoms related to the engraftment of hematopoietic stem cells. A tissue biopsy can be helpful, but there are times when a diagnosis is not confirmed, and a clinical judgment must be made.

Chronic GVHD may result in conditions like lichenification and keratosis.