Skin Health after Childhood Cancer


When keeping tabs on your health don't forget about your skin. Treatment for childhood cancer can damage this often overlooked organ, which is the body's first line of defense against outside invaders, like germs.

Am I at Risk?

Survivors who received radiation to any part of the body, including total body irradiation are at risk for skin damage, including skin cancer. Those who have chronic graft-versus-host-disease (GVHD) from a bone marrow or stem cell transplant may also develop skin problems, such as scleroderma and vitiligo.

What Are the Possible Effects from Radiation?

The long-term effects of radiation on your skin are generally mild and occur within the radiation field. They include the following conditions:

  • Spider veins – Called telangiectasias, these are small blood vessels on the surface of the skin. They don't typically cause any health problems or require specific care.
  • Fibrosis – Scarring of the lining of the blood vessels causes a "woody" skin texture called fibrosis. Fibrotic skin can be injured more easily and take longer to heal. To care for fibrotic skin use moisturizer regularly and try to avoid cuts and scrapes.
  • Hyperpigmentation – or darkening of the skin or nails – can occur after radiation and some types of chemotherapy. There is no specific treatment for it but it usually fades over time.
  • Skin cancer – If diagnosed early, skin cancer is usually very treatable. The most common type of skin cancer (which is rarely deadly) is called basal cell carcinoma. At first it usually looks like a rough, raised area of skin. It then may turn into a sore that won't heal. Squamous cell carcinoma also appears like a sore that won't heal, but it's more likely than basal cell carcinoma to travel to other tissues and body parts. The most serious skin cancer is called melanoma. It usually arises from moles. If untreated it can spread to other organs and be deadly. 

What Are the Possible Effects from Graft-Versus-Host-Disease?

The long-term effects of graft-versus host disease (GVHD) include scleroderma and vitiligo. Therapy for both centers around treating the underlying GVHD. 

  • Scleroderma – Donor white blood cells attack your own skin cells, making your skin become stiff. If this occurs on skin around your joints they can become less mobile.
  • Vitiligo – Donor white blood cells attack your skin cells that control skin color, causing loss of pigment on patches of your skin. It's important to protect these patches from the sun by using sunscreen before going outdoors.

What Can I Do to Keep My Skin Healthy?

Check your skin monthly and have a clinician examine it at least yearly if you have any of the following factors that increase risk for skin problems:

  • You received radiation.
  • You or someone in your family has had skin cancer or melanoma.
  • You have abnormal moles.
  • You had severe sunburn as a young child.

If you have moles, look for "ABCD" warning signs:

Asymmetry – one half of the mole looks different than the other half.

Border – the border of the mole is irregular, scalloped, or poorly defined.

Color – changes in color appear from one area of the mole to another area.

Diameter – the mole is larger than 6 millimeters, about as wide as a pencil eraser.

Have your doctor check out moles with any of these signs. It might need to be removed.

Here are some other ways to protect your skin:

  • Wear protective clothes or use sunscreen with an SPF (sun protection factor) of at least 15 when you'll be exposed to the sun. Reapply sunscreen or use water resistant sunscreen when sweating a lot or swimming.
  • Take extra care to protect your skin when you are in sand, snow, concrete, water, or high altitudes. They increase risk for sun damage.
  • Don't try to get a tan, including using tanning booths.
  • Plan outdoor activities for when the sun’s rays are less intense, during the early morning or late afternoon hours.

What Should I Talk to My Doctor About?

Ask your doctor to check your skin at least yearly if you had radiation or if you have any other risk factors for skin problems.

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