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- Asymptomatic coronary artery disease
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SUBSEQUENT NEOPLASMS: SKIN CANCER
This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.
On this page you can find:
This brochure is a sequel to the brochure Subsequent neoplasms: general. Please read that brochure first before you continue.
This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.
PLAIN version 2.1: 27/05/2024
Subsequent cancer: skin cancer
Our skin is very complex and has many functions. For example, the skin protects us from bad bacteria, viruses and toxins. It also allows us to feel sensations such as touch or heat and cold.
The skin contains different types of skin cells, such as basal cells, melanocytes and squamous cells. Sometimes, the cells that make up the skin can become malignant. This means that they do not work properly anymore and multiply uncontrollably, causing a tumour to grow. When this happens, this is called skin cancer.
Different types of skin cancer include:
- Basal cell carcinoma, where the basal cells become malignant.
- Squamous cell carcinoma, where the squamous cells become malignant.
- Melanoma, where the melanocytes become malignant. Melanoma is the most aggressive, but also least common type of skin cancer.
Due to treatment of the first cancer, survivors sometimes have a higher risk of skin cancer. There are a number of things anyone can do to lower the risk of skin cancer, such as avoiding (too much) sun exposure, especially in the middle of the day.
The skin
Created with BioRender.com
Hover over the numbers in the figure for more information.
Survivors
Am I at higher risk of skin cancer?
Anyone, including people who have never had cancer treatment, may develop skin cancer. However, there are some cancer treatments that may increase the risk of having skin cancer as a subsequent cancer later in life.
The following treatments can increase the risk of skin cancer:
- Radiotherapy. The part of the body treated with radiotherapy is at higher risk of developing skin cancer.
- Stem cell transplantation, especially with a history of skin graft versus host disease (GvHD)
You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.
If you develop skin cancer, it does not always mean that this is caused by treatment for your first cancer. Skin cancer may have other causes, such as (too much) sun exposure. Skin cancer is most common in people with a light skin type and older age. If cancer at an unusually young age is common in your family, this may also increase your risk of having skin cancer.
Graft versus host disease
Stem cell transplantation is a type of cancer treatment that involves taking stem cells from the blood of a donor (‘graft’) and putting them in your body (‘host’). Sometimes these stem cells can attack your own cells because they falsely recognize them as foreign and attack them. This is called GvHD.
GvHD can have serious health implications when you are experiencing it but it can also put you at higher risk of some late effects.
Stem cell transplantation
Stem cell transplantation means that blood stem cells are taken out of the body of a person and transplanted back into the same person (autologous) or to another person (allogeneic).
This procedure is often used to treat diseases such as leukaemia and lymphoma, and some solid tumours (such as neuroblastoma) as well as certain immune system and genetic disorders.
There are different types of stem cell transplants, including:
- Autologous Transplant: Uses the patient’s own stem cells, which are harvested before treatments like chemotherapy or radiation and then returned to the body to help recover.
- Allogeneic Transplant: Uses stem cells from a donor. The donor can be a relative (often a sibling) or someone unrelated with a matching tissue type.
The blood stem cells can be harvested in different ways. They can either be taken out of the blood stream (peripheral blood stem cell transplantation) or out of the bone marrow (bone marrow transplantation).
During the transplantation process, the patient often undergoes a treatment to kill the diseased bone marrow cells before receiving the new stem cells through an intravenous line, similar to a blood transfusion. After the transplant, it takes time for the new stem cells to grow and start producing healthy blood cells, during which the patient needs close medical care to prevent and manage potential complications, such as infections or graft-versus-host disease (in case of allogeneic transplants).
Radiotherapy
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, do contact your treating hospital.
Radiotherapy is a treatment for cancer which uses high-energy radiation to destroy cancer cells and to shrink tumours. The radiation comes from a machine outside the body (external beam radiotherapy) or occasionally from radioactive material that is placed in the body near cancer cells (intracavitary or interstitial radiotherapy). The aim of radiotherapy is to treat only one area of the body, around and near the cancer or where the cancer was before it was removed by surgery and as far as possible to protect unaffected areas. For example, if you have cancer in your lung, you will have radiation only to your chest, not to your whole body.
External beam radiotherapy is painless and takes only a few minutes. It is given once or occasionally twice a day often for several weeks. A radiation beam is like an invisible light beam. The machines which produce the radiation beam can be moved so that the beam enters the body from different directions, ‘spotlighting’ on the area to be treated. This means that the tumour is given a high dose whilst normal areas get either a lower or no dose at all.
Since the early 1980’s computers and other technical advances have improved radiotherapy. Before this there were not many ways to protect normal tissues which were in the path of a radiation beam. Even now, whilst modern techniques allow doctors to target the cancer cells more precisely than older techniques, healthy cells may still get damaged. This can result in some of the late effects covered in the PLAIN summaries. It will help you and your follow up specialist to know what long term effects there might be after your radiotherapy if you and they have your treatment summary.
Your treatment summary can tell you which areas of your body were irradiated. If you do not have a treatment summary or if you don’t understand what is written about the radiotherapy you received, please contact your treating hospital.
What are the symptoms and signs of skin cancer?
There are symptoms and signs that can tell you if you might have skin cancer. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.
These symptoms and signs may suggest that you have basal cell carcinoma:
- Raised, transparent or pearly bump(s) on the skin
- Scaly patch(es) on the skin
- Red, itchy patch(es) on the skin
- Patches with brown or black spots in them
- A sore that does not heal, or heals but comes back
Symptoms and signs of squamous cell carcinoma are:
- A firm, pink lump with a scaly crust
- A lump that bleeds easily
- Pain or tenderness where the lump is located
Symptoms and signs of melanoma are:
- A spot that looks like a mole
- A new or newly changed spot that does not go away
To help distinguish melanoma from a regular mole, you can use the ABCDE rule:
Symptoms and signs
Pain
From a physical point of view, pain is a life-sustaining biological reaction to damaging influences – even if tissue damage has not yet occurred. Due to its function as a damage indicator or warning, pain is usually associated with negative feelings so that we pay sufficient attention to it and learn as quickly as possible when it is dangerous for us. How intensely we feel a pain stimulus, whether it causes us to feel fear and panic, depends not only on the pure nerve signal, but is an interplay of biological, psychological and social factors.
All pain whose duration exceeds the extent of an acute (recent) cause and lasts for an incomprehensibly long time is called chronic pain. Strong and prolonged pain stimuli can make the transmitting nerve cells of the spinal cord and brain more sensitive to subsequent pain stimuli. This means that even mild stimuli can be perceived as severe pain. Under certain circumstances, these nerve cells, which have become hypersensitive
A | Asymmetry | Melanomas are often asymmetric in shape, whereas moles are symmetric. |
B | Border | The border of melanomas is often uneven, or ragged. |
C | Colour | A mole usually has one colour, whereas melanomas are often a mix of 2 or more colours. |
D | Diameter | Melanomas are often larger (> 6 mm) than moles (< 6 mm). |
These symptoms and signs are often caused by something else. However, early diagnosis and treatment of skin cancer is very important. If you experience any of these symptoms or signs, please contact your general practitioner or follow-up care specialist soon.
Soon
I am at higher risk of skin cancer. What tests should I have and when?
If you are at higher risk of skin cancer, it is highly recommended to inspect your skin every 6 months for new spots or changing moles. If you suspect skin cancer, or when you are in doubt, show the bump, patch or mole to your general practitioner or follow-up care specialist.
It is also advised to:
- Discuss your family history of skin cancer with your follow-up care specialist at least every 2 years.
- Have a skin exam done at least every 2 years.
What happens if I (might) have skin cancer?
If you have a bump, patch or mole that may be skin cancer, your general practitioner or follow-up care specialist will refer you to a:
- Dermatologist (physician specialised in the skin)
The dermatologist may discuss different treatment options with you. When diagnosed early, most skin cancers can be removed easily.
What else can I do?
Knowing that you may be at increased risk of subsequent cancer can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.
To lower your risk of skin cancer, adopting or maintaining a healthy lifestyle is extremely important. In particular, it is important to avoid (too much) sun exposure, especially in the middle of the day. When you go outside, it is recommended to use sunscreen with a high SPF and wear protective clothing. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.
It is important that you are aware of the possibility of developing skin cancer and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.
Healthy lifestyle
- Having a healthy diet
- Drinking less (or no) alcohol
- Exercising regularly
- Quitting smoking (if you smoke)
Your follow-up care specialist or general practitioner may give you additional advice tailored to your individual situation for maintaining a healthy lifestyle. For more information on taking up a healthier lifestyle, please read: Health promotion.
Where can I find more information?
You may find more information about skin cancer online. However, it is important to be aware that this information is not always up to date or accurate.
On this website, you can also find more information related to this topic:
Please note
This PLAIN summary is based on the PanCareFollowUp guideline about “Subsequent neoplasms” [1], which is based on the consensus of different national guidelines.
While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.
Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.
No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.
The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.
[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: https://www.ejcancer.com/article/S0959-8049(21)00368-3/fulltext.