Skin Problems, ASCO's curriculum


The skin is an organ that protects the body from infection. Because skin is on the outside of the body and visible to others, many people have difficulty coping with skin problems. In addition, skin problems can be painful because the skin contains many nerves. As with other side effects, prevention or early treatment of skin problems is best. With established skin problems, treatment and wound care can often improve pain symptoms and quality of life.

With most skin problems, the doctor must decide if healing the wound is a realistic goal. If it is not, then containing it and keeping the patient as comfortable and pain-free as possible becomes the goal.

Some common skin problems experienced by people with cancer are listed below.

Chemotherapy extravasation. This is the term used to describe chemotherapy drugs leaking out of a vein. The drugs can damage the skin where the intravenous (IV) tube was placed or the tissue around the area it touches, causing pain or burning. Pain or burning during chemotherapy may not be normal, and you should tell the nurse or doctor right away. If an extravasation occurs during treatment, the infusion should be stopped and the wound cleaned. The nurses and doctors will care for the wound and instruct you how to care for it at home.

Radiation-induced treatment skin problems. When radiation treatment kills cancer cells, it also kills some healthy cells. When it kills cells on the skin, it can cause the skin to peel. Damage to the skin from radiation treatment can start after one or two weeks of treatment and usually resolves a few weeks after treatment is finished. If skin damage from radiation treatment becomes a problem, the doctor may change the dose or schedule of treatments.

Necrotic wound. This is a wound with dead skin or tissue around it. A necrotic wound cannot heal if the dead tissue is still present, so removing the dead tissue is the first step in treating it. This process is called debridement and may involve surgery, enzymes or gel, or other methods.

Pressure ulcers (bed sores). Pressure ulcers are sores that form where there is constant pressure on one area of the body. They often form on the heels of the feet or the sacrum (tailbone). Ulcers are less likely to form on parts of the body where there is a thicker layer of fat.

For patients who are confined to a bed, an air or water mattress overlay may help prevent ulcers. Low-air-loss beds or air-fluidized beds may also help. For pressure ulcers that are not expected to heal, providing comfort and pain control and preventing ulcers from getting worse become the main goals.

Malignant wounds. These injuries form when cancer breaks the skin and causes a wound. A malignant wound can be caused by cancer from another part of the body or from skin cancer. These wounds may have a foul odor, bleed, and can be very painful.

Malignant wounds carry a high risk of infection. They may also exudate, or secrete, a large amount of fluid or blood. The odor from a malignant wound can be overpowering and can be managed by placing a competing odor or odor absorber in the room, such as cat litter, charcoal, or coffee.

Pruritus. This is the medical term for itching. Pruritus in people with cancer is most often caused by leukemia, lymphoma, myeloma, or other cancers. Kidney or liver failure, thyroid problems, a drug reaction, dry skin, hives, and other skin infections can also cause itching.

Pruritus that is caused by an irritant, such as a drug, can be treated by stopping the use of that drug. Moisturizers, antihistamines, steroid medications, and cooling or painkilling creams or gels may also help relieve itching.

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