US Cutaneous Oncodermatology Management (USCOM): A Practical Algorithm

September 2021 | Volume 20 | Issue 9 | Supplement Individual Articles | 3ss | Copyright © September 2021

Published online September 1, 2021

Mario E. Lacouture MD,a Jennifer Choi MD,b Alice Ho MD,c Jonathan Leventhal MD,d Beth N. McLellan MD,e Anneke Andriessen PhD,f Maxwell B. Sauder MD,g Edith Mitchell MDh

aOncodermatology, Memorial Sloan Kettering Cancer Center, New York, NY
bOncodermatology Program, Department of Dermatology, Northwestern University Feinberg School of Medicine, Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL
cRadiation Oncology, Massachusetts General Hospital, Memorial Sloan Kettering Cancer Center, New York, NY
dOncodermatology, Smilow Cancer Hospital at Yale, New Haven, CT
eMontefiore's Division of Dermatology and Montefiore Einstein Center for Cancer Care; Dermatology, Jacobi Medical Center, New York, NY fRadboud UMC, Nijmegen and Andriessen Consultants, Malden, The Netherlands
gOncodermatology, Princess Margaret Cancer Centre, Pigmented Lesion Clinic, Toronto Dermatology Disparities; Gastrointestinal Centre, Toronto, ON, Canada
hCenter to Eliminate Cancer Disparities, Gastrointestinal Oncology, Thomas Jefferson University Hospital and Jefferson Methodist Hospital, Philadelphia, PA

includes skin hygiene, moisturization, sun protection, and, if applicable, camouflage products (Table 4).46-48,50

Statement 8: Skin cleansing, skin hydration, and photoprotection should be considered in cancer patients and survivors to prevent and manage cutaneous side effects before, during, and after cancer therapy.

Skincare, including gentle cleansers, moisturizers that help restore skin barrier integrity and function, photoprotection using sun avoidance measures, and sunscreen, is to be used throughout the patient's cancer care. The skin care products used for patients undergoing cancer therapy should be safe, effective, free of additives, fragrances, perfumes, and sensitizing agents, and should have a near physiologic (skin surface) pH.12,46-48,50 The skincare regimen should be tailored to the individual patient, cosmetically pleasant, and easy to use (Box 4: Skincare instructions).12,46,50

Various papers on prevention and treatment of cAEs using skincare for the specific cancer-treatments have demonstrated benefits.8,12,18,20,22,25,26,29,43,45-48,50

A study including 253 women with breast cancer undergoing radiation treatment evaluated the tolerability and benefit of a skincare regimen for preventing radiation dermatitis.46 The study assessed the advantage of using thermal water containing OTC skincare regimen that included a cleanser, emollient, wound healing cream, and sunscreen in preventing radiation dermatitis. During the 6-week radiation treatment period, those who used skincare every day had fewer cAEs than those who applied less skincare. The evaluated skincare regimen is in line with recommendations to use skincare products to reduce cAEs and their impact on those receiving radiation treatment.43-50

Unsuitable skincare products are those with allergens and irritants such as common preservatives causing allergy, fragrances, and perfumes.50 Soaps, surfactants, and detergents, especially those with an alkaline pH (>7), remove skin lipids, elevate skin surface pH, and lower the skin microbiome's diversity is explicitly damaging for cancer patients and those at risk for cancer treatment-related cAEs.50,52,53

Moisturizers form a barrier that retains water by preventing transepidermal water loss (TEWL).46 However, some clinicians recommend avoiding the use of occlusive moisturizers and topical medications as they may cause maceration or trigger infection.18,50

Use AHA's with caution as they can change the pH and be irritants.12,50

Moisturizers containing lipids help restore the skin barrier function or maintain its integrity.53 Skincare such as those containing panthenol provides good skin penetration when administered in an adequate vehicle, such as water-in-oil emulsions. The skincare helps improve stratum corneum hydration, reducing transepidermal water loss and maintaining skin softness and elasticity.46
Contrary to the advice many cancer patients receive when undergoing radiation treatment, skincare does not interfere with or increase the radiation dose to the skin and can be used in moderation before radiation treatments.54 Even if applied shortly before radiation treatment, thin or moderately applied skincare will have minimal influence on skin radiation dose.54 Frequently, patients are concerned about toxic effects on the skin.54 Allowing patients to apply skincare throughout their radiation treatment period will simplify patient instructions and reduce patient confusion and anxiety.54 Providing patients with clear instructions on how to apply skincare on a daily basis throughout radiation routinely is likely to improve patient quality of life and adherence to the prevention and management of cAEs using skincare.12,50,54,55

The use of antiperspirants for patients undergoing radiation treatment for breast cancer seems to be equally safe. A study showed no difference in surface radiation dose nor an increased toxic effect when using antiperspirants during radiation therapy.56

Challenges to implementing a skincare regimen include