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

Sauder et al (2020) emphasized the need for evolving, ongoing, and frequent communication with the patient throughout their cancer care while checking if they have processed and understood the information.12 Providing patients understand the significance of prevention measures using skincare and early reporting of new and worsening cAEs, it may be easier to resolve the condition and prevent disruption or discontinuation of cancer treatment.8,9-12

The USCOM Algorithm
The USCOM algorithm uses the Common Terminology Criteria for Adverse Events (CTCAE) grading system v5 with five grades (1 = mild to 5 = lethal) (Table 3).49 For cAEs, the five grades do not apply to all cAEs. The USCOM algorithm defined grade 3 (Severe, medically significant but not immediately life-threatening) and Grade 4 (Life-threatening consequences urgent intervention indicated) conditions to be followed up immediately. Further symptoms to investigate and follow up immediately are fever, pain, mucosal involvement, and significant laboratory abnormalities.

The algorithm focuses on the cAEs that can benefit from skincare use. Altered skin barrier functions related to cancer or cancer treatment that may benefit from skincare include xerosis, keratosis pilaris, fissures, pruritus, radiation dermatitis, hand and foot syndrome (HFS), and nail toxicities.12 Papulopustular eruptions and rashes such as eczema, lichenoid reactions, and others resulting from innate immunity alterations may also benefit from skincare.12

Statement 7: Education and proper skincare may help optimize skin health and quality of life in patients undergoing active cancer treatment and cancer survivors.

Patients should be educated on preventive measures, recognizing cAEs, and contacting the oncology team.12,50 Oncology patients may underreport their cAEs or not want to bother the oncology team for something they do not recognize as potentially serious or at risk of interrupting their cancer treatment.12,50 Frequently, patients assume the cAE is due to an allergy, weather conditions, diet, or stress.12 A glossary containing photographs and a checklist for identifying the cAE risk may support non-dermatologists to undertake effective action (Figure 4). Further, a checklist for identifying cAEs that are serious or even life-threatening may support early recognition and reporting. (Box 3: Checklist – assess the risk of the cutaneous AE).12,49,50

The USCOM panel recommends initiating general preventive measures for cAEs such as avoiding skin irritants, scented products, temperature extremes, and sun exposure. Further, they recommended patients use sun-protective clothing (eg, brim hats and sunglasses).12,50 Recommendations include that patients always liberally and daily use a skincare regimen that