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Skin Problems in Childhood Cancer Survivors

Some cancer treatments can cause long-term skin problems. One of these problems can be skin cancer. But there are other non-cancerous skin conditions that can occur.

Certain skin conditions do not cause health problems and don’t require medical treatment. Others may cause skin to be more prone to injury and require care and protection.

It is important to keep skin healthy. It is the body’s first line of defense against infections.

Role of the Skin

The skin protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D.

Skin has several layers. The outer layer is the epidermis. It is composed of 3 kinds of cells:

  • Squamous: Thin, flat cells that form the top layer of the epidermis.
  • Basal: Round cells under the squamous cells.
  • Melanocytes: Cells located in the deepest part of the epidermis that produce melanin. Melanin gives color (pigment) to the skin and helps protect the skin from ultraviolet (UV) radiation from the sun.

Cancer Treatments that May Cause Non-Cancerous Skin Problems

  • Radiation — typically in the area that received radiation.
  • Hematopoietic cell transplant (also known as bone marrow transplant or stem cell transplant)
  • Certain chemotherapy medicines

Skin Conditions that May Happen After Cancer Treatment

  1. Telangiectasias are commonly called spider veins. They are small vessels on the surface of the skin.

    They can appear in the areas where the patient received radiation.

    They happen because radiation causes change to the lining of blood vessels.

    Spider veins usually do not cause health problems.

  2. Fibrosis is caused by scarring of the lining of the blood vessels. It gives the skin a “woody” texture.

    The skin may not be as flexible as healthy skin.

    Moisturizing the area can help protect the skin from injury such as cuts and scrapes.

    Healing can be slow in these areas because the blood supply is not as good.

  3. Scleroderma may present in patients with chronic graft versus host disease after a hematopoietic cell transplant (sometimes called bone marrow transplant or stem cell transplant.)

    Scleroderma occurs when donor white blood cells attack the patient’s skin cells.

    The skin becomes stiff. If this happens in the skin around joints, joint mobility can be affected.

    Treatment for scleroderma is focused on treating the chronic GVHD.

    It is also important to avoid injury to affected skin that can be slow to heal.

  4. Vitiligo may appear after transplant. It is a loss of pigment on patches of skin.

    Vitiligo occurs because donor white blood cells attack the patient’s skin cells called melanocytes. These cells control skin color.

    Vitiligo happens because of graft versus host disease or other autoimmune disorders. Treating the underlying disease may not cause the color to return to the white patches because damage may be permanent.

    It is important to protect skin without pigment because is vulnerable to sun damage.

  5. Hyperpigmentation is a darkening of the skin or nails. It may occur after radiation or some types of chemotherapy. The chemotherapy agents most commonly associated with hyperpigmentation include:

    Hyperpigmentation usually fades over time without any treatment.

What Survivors Can Do About Skin Problems

Know Your Risk and Monitor Your Health

  • Know your risk of developing skin problems. Ask your doctor if you received treatments that increase your risk.
  • Share a copy of your Survivorship Care Plan with your health care providers. The report includes details about your cancer treatment and health problems that may occur because of your treatment.

For more information, visit the Children’s Oncology Group’s Skin Health After Cancer Treatment Health Link.

Reviewed: June 2020