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Symptoms of and Palliative Treatment for Unresectable Skin Cancer

  • Hiroyuki GotoEmail author
  • Yoshio Kiyohara
  • Masahisa Shindo
  • Osamu Yamamoto
Skin Cancer (T Ito, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Skin Cancer

Opinion statement

The symptom prevalence in patients with advanced cancer depends on the type of primary cancer, and the palliative treatment varies according to the nature of the primary cancer. Palliative treatment for unresectable skin cancer has not been fully discussed. Patients with unresectable skin cancer sometimes show the primary lesion in the skin and metastases to the lung, skin, liver, and bone. Pain, anorexia, and dyspnea commonly occur in such patients, and bleeding, exudate, and offensive odor are characteristically observed. For the last three symptoms, surgery and radiation are effective therapeutic options, and cryotherapy, Mohs’ chemosurgery, electrochemotherapy, and some topical ointments and dressing materials are also additional options. For pain due to bone metastasis, pharmacotherapy with opioid and/or non-opioid agents is the most basic treatment, and radiation and bisphosphonate therapies are other options. For dyspnea, which is an intractable and uncomfortable symptom, morphine and oxygen play a leading role in treatment. Red blood cell transfusions may be effective for some patients with dyspnea induced by anemia. Nutritional supports and pharmacotherapy are therapeutic options for anorexia. As nutritional supports, enteral nutrition is better than parenteral nutrition. There is some evidence of progestins and corticosteroids having supportive effects for anorexia. Dermatologic oncologists should be skilled with symptom managements to maintain the quality of life in patients with unresectable skin cancer and their families.

Keywords

Skin cancer Palliative care Metastasis Quality of life 

Notes

Compliance with Ethical Standards

Conflict of Interest

Hiroyuki Goto, Yoshio Kiyohara, Masahisa Shindo, and Osamu Yamamoto declare they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Leiter U, Eigentler T, Garbe C. Epidemiology of skin cancer. Adv Exp Med Biol. 2014;810:120–40.PubMedGoogle Scholar
  2. 2.
    Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012;166(5):1069–80.  https://doi.org/10.1111/j.1365-2133.2012.10830.x.CrossRefPubMedGoogle Scholar
  3. 3.
    Tomizuka T, Namikawa K, Higashi T. Characteristics of melanoma in Japan: a nationwide registry analysis 2011-2013. Melanoma Res. 2017;27(5):492–7.  https://doi.org/10.1097/cmr.0000000000000375.CrossRefPubMedGoogle Scholar
  4. 4.
    Ito T, Kaku-Ito Y, Furue M. The diagnosis and management of extramammary Paget’s disease. Expert Rev Anticancer Ther. 2018;18(6):543–53.  https://doi.org/10.1080/14737140.2018.1457955.CrossRefPubMedGoogle Scholar
  5. 5.
    •• Goto H, Yoshikawa S, Otsuka M, Omodaka T, Yoshimi K, Yoshida Y, et al. Symptom prevalence in patients with advanced skin cancer. J Dermatol. 2017;44(2):123–6.  https://doi.org/10.1111/1346-8138.13527 The first study on symptom prevalence in patients with unresectable skin cancer.CrossRefPubMedGoogle Scholar
  6. 6.
    Morita T, Tsunoda J, Inoue S, Chihara S. Contributing factors to physical symptoms in terminally-ill cancer patients. J Pain Symptom Manag. 1999;18(5):338–46.CrossRefGoogle Scholar
  7. 7.
    Salama AK, Rosa N, Scheri RP, Herndon JE, Tyler DS, Marcello J, et al. The effect of metastatic site and decade of diagnosis on the individual burden of metastatic melanoma: contemporary estimates of average years of life lost. Cancer Investig. 2012;30(9):637–41.  https://doi.org/10.3109/07357907.2012.726387.CrossRefGoogle Scholar
  8. 8.
    Einhorn LH, Burgess MA, Vallejos C, Bodey GP Sr, Gutterman J, Mavligit G, et al. Prognostic correlations and response to treatment in advanced metastatic malignant melanoma. Cancer Res. 1974;34(8):1995–2004.PubMedGoogle Scholar
  9. 9.
    Brougham ND, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol. 2012;106(7):811–5.  https://doi.org/10.1002/jso.23155.CrossRefPubMedGoogle Scholar
  10. 10.
    Cai Y, Sheng W, Xiang L, Wu X, Yang H. Primary extramammary Paget’s disease of the vulva: the clinicopathological features and treatment outcomes in a series of 43 patients. Gynecol Oncol. 2013;129(2):412–6.  https://doi.org/10.1016/j.ygyno.2013.02.029.CrossRefPubMedGoogle Scholar
  11. 11.
    Kim IY, Yun SJ, Lee JS, Jung S, Jung TY, Moon KS, et al. Brain metastasis from extramammary Paget’s disease of the scrotum. J Clin Neurosci. 2014;21(4):694–6.  https://doi.org/10.1016/j.jocn.2013.05.027.CrossRefPubMedGoogle Scholar
  12. 12.
    Jones IS, Crandon A, Sanday K. Paget’s disease of the vulva: diagnosis and follow-up key to management; a retrospective study of 50 cases from Queensland. Gynecol Oncol. 2011;122(1):42–4.  https://doi.org/10.1016/j.ygyno.2011.03.033.CrossRefPubMedGoogle Scholar
  13. 13.
    Cappuccini F, Tewari K, Rogers LW, DiSaia PJ. Extramammary Paget’s disease of the vulva: metastases to the bone marrow in the absence of an underlying adenocarcinoma--case report and literature review. Gynecol Oncol. 1997;66(1):146–50.  https://doi.org/10.1006/gyno.1997.4735.CrossRefPubMedGoogle Scholar
  14. 14.
    Ito T, Uchi H, Nakahara T, Tsuji G, Oda Y, Hagihara A, et al. Cutaneous angiosarcoma of the head and face: a single-center analysis of treatment outcomes in 43 patients in Japan. J Cancer Res Clin Oncol. 2016;142(6):1387–94.  https://doi.org/10.1007/s00432-016-2151-2.CrossRefPubMedGoogle Scholar
  15. 15.
    Kouzmina M, Koljonen V, Leikola J, Bohling T, Lantto E. Frequency and locations of systemic metastases in Merkel cell carcinoma by imaging. Acta Radiol Open. 2017;6(3):2058460117700449.  https://doi.org/10.1177/2058460117700449. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kahler KC, Egberts F, Gutzmer R. Palliative treatment of skin metastases in dermato-oncology. J Dtsch Dermatol Ges. 2013;11(11):1041–5; quiz 6.  https://doi.org/10.1111/ddg.12197.PubMedGoogle Scholar
  17. 17.
    Gaulin C, Sebaratnam DF, Fernandez-Penas P. Quality of life in non-melanoma skin cancer. Australas J Dermatol. 2015;56(1):70–6.  https://doi.org/10.1111/ajd.12205.CrossRefPubMedGoogle Scholar
  18. 18.
    • Wordliczek J, Kotlinska-Lemieszek A, Leppert W, Woron J, Dobrogowski J, Krajnik M, et al. Pharmacotherapy of pain in cancer patients - recommendations of the Polish Association for the Study of Pain, Polish Society of Palliative Medicine, Polish Society of Oncology, Polish Society of Family Medicine, Polish Society of Anaesthesiology and Intensive Therapy and Association of Polish Surgeons. Pol Przegl Chir. 2018;90(4):55–84.  https://doi.org/10.5604/01.3001.0012.2904 A recent article on pharmacotherapy for pain in cancer patients.CrossRefPubMedGoogle Scholar
  19. 19.
    Cheung WY, Zimmermann C. Pharmacologic management of cancer-related pain, dyspnea, and nausea. Semin Oncol. 2011;38(3):450–9.  https://doi.org/10.1053/j.seminoncol.2011.03.016.CrossRefPubMedGoogle Scholar
  20. 20.
    Ripamonti C, Fulfaro F, Bruera E. Dyspnoea in patients with advanced cancer: incidence, causes and treatments. Cancer Treat Rev. 1998;24(1):69–80.CrossRefGoogle Scholar
  21. 21.
    Pressoir M, Desne S, Berchery D, Rossignol G, Poiree B, Meslier M, et al. Prevalence, risk factors and clinical implications of malnutrition in French Comprehensive Cancer Centres. Br J Cancer. 2010;102(6):966–71.  https://doi.org/10.1038/sj.bjc.6605578.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Teunissen SC, Wesker W, Kruitwagen C, de Haes HC, Voest EE, de Graeff A. Symptom prevalence in patients with incurable cancer: a systematic review. J Pain Symptom Manag. 2007;34(1):94–104.  https://doi.org/10.1016/j.jpainsymman.2006.10.015.CrossRefGoogle Scholar
  23. 23.
    Goto H, Omodaka T, Yanagisawa H, Yoshikawa S, Yoshida Y, Yamamoto O, et al. Palliative surgical treatment for cutaneous metastatic tumor is a valid option for improvement of quality of life. J Dermatol. 2016;43(1):95–8.  https://doi.org/10.1111/1346-8138.12983.CrossRefPubMedGoogle Scholar
  24. 24.
    Barnes EA, Breen D, Culleton S, Zhang L, Kamra J, Tsao M, et al. Palliative radiotherapy for non-melanoma skin cancer. Clin Oncol (R Coll Radiol). 2010;22(10):844–9.  https://doi.org/10.1016/j.clon.2010.07.014.CrossRefGoogle Scholar
  25. 25.
    Hachisuka J, Doi K, Furue M. Combination cryosurgery with hyperthermia in the management of skin metastasis from breast cancer: a case report. Int J Surg Case Rep. 2012;3(2):68–9.  https://doi.org/10.1016/j.ijscr.2011.10.016.CrossRefPubMedGoogle Scholar
  26. 26.
    Johanson CR, Harwood AR, Cummings BJ, Quirt I. 0-7-21 radiotherapy in nodular melanoma. Cancer. 1983;51(2):226–32.CrossRefGoogle Scholar
  27. 27.
    Dawber R. Cryosurgery: unapproved uses, dosages, or indications. Clin Dermatol. 2002;20(5):563–70.CrossRefGoogle Scholar
  28. 28.
    Uno H, Sasaki M, Osamura K, Ohtoshi S, Nakada T, Iijima M. Angiosarcoma (Stewart-Treves syndrome): palliative role of Mohs’ ointment. J Dermatol. 2010;37(9):852–3.  https://doi.org/10.1111/j.1346-8138.2010.00898.x.CrossRefPubMedGoogle Scholar
  29. 29.
    Omigawa C, Hashimoto T, Hanafusa T, Namiki T, Igawa K, Yokozeki H. Modified method for applying Mohs’ paste. J Dermatol. 2017;44(12):e353–e4.  https://doi.org/10.1111/1346-8138.14030.CrossRefPubMedGoogle Scholar
  30. 30.
    Nakai N, Okuzawa Y, Katoh N. Clinical usefulness of Mohs’ chemosurgery for palliative purposes in patients with cutaneous squamous cell carcinoma with risk factors or without indication for surgery: three case reports. J Dermatol. 2015;42(4):405–7.  https://doi.org/10.1111/1346-8138.12767.CrossRefPubMedGoogle Scholar
  31. 31.
    Kreuter A, van Eijk T, Lehmann P, Fischer M, Horn T, Assaf C, et al. Electrochemotherapy in advanced skin tumors and cutaneous metastases - a retrospective multicenter analysis. J Dtsch Dermatol Ges. 2015;13(4):308–15.  https://doi.org/10.1111/ddg.12583.CrossRefPubMedGoogle Scholar
  32. 32.
    da Costa Santos CM, de Mattos Pimenta CA, Nobre MR. A systematic review of topical treatments to control the odor of malignant fungating wounds. J Pain Symptom Manag. 2010;39(6):1065–76.  https://doi.org/10.1016/j.jpainsymman.2009.11.319.CrossRefGoogle Scholar
  33. 33.
    Yosipovitch G, Mills KC, Nattkemper LA, Feneran A, Tey HL, Lowenthal BM, et al. Association of pain and itch with depth of invasion and inflammatory cell constitution in skin cancer: results of a large clinicopathologic study. JAMA Dermatol. 2014;150(11):1160–6.  https://doi.org/10.1001/jamadermatol.2014.895.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Ventafridda V, Ripamonti C, De Conno F, Tamburini M, Cassileth BR. Symptom prevalence and control during cancer patients’ last days of life. J Palliat Care. 1990;6(3):7–11.CrossRefGoogle Scholar
  35. 35.
    Gough N, Miah AB, Linch M. Nonsurgical oncological management of cancer pain. Curr Opin Support Palliat Care. 2014;8(2):102–11.  https://doi.org/10.1097/spc.0000000000000043.CrossRefPubMedGoogle Scholar
  36. 36.
    Zeng L, Chow E, Bedard G, Zhang L, Fairchild A, Vassiliou V, et al. Quality of life after palliative radiation therapy for patients with painful bone metastases: results of an international study validating the EORTC QLQ-BM22. Int J Radiat Oncol Biol Phys. 2012;84(3):e337–42.  https://doi.org/10.1016/j.ijrobp.2012.05.028.CrossRefPubMedGoogle Scholar
  37. 37.
    Aapro M, Abrahamsson PA, Body JJ, Coleman RE, Colomer R, Costa L, et al. Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Ann Oncol. 2008;19(3):420–32.  https://doi.org/10.1093/annonc/mdm442.CrossRefPubMedGoogle Scholar
  38. 38.
    Ripamonti C, Bruera E. Dyspnea: pathophysiology and assessment. J Pain Symptom Manag. 1997;13(4):220–32.CrossRefGoogle Scholar
  39. 39.
    Hui D, Morgado M, Vidal M, Withers L, Nguyen Q, Chisholm G, et al. Dyspnea in hospitalized advanced cancer patients: subjective and physiologic correlates. J Palliat Med. 2013;16(3):274–80.  https://doi.org/10.1089/jpm.2012.0364.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Guirimand F, Sahut d'izarn M, Laporte L, Francillard M, Richard JF, Aegerter P. Sequential occurrence of dyspnea at the end of life in palliative care, according to the underlying cancer. Cancer Med. 2015;4(4):532–9.  https://doi.org/10.1002/cam4.419.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Hui D, Morgado M, Chisholm G, Withers L, Nguyen Q, Finch C, et al. High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: a phase II randomized trial. J Pain Symptom Manag. 2013;46(4):463–73.  https://doi.org/10.1016/j.jpainsymman.2012.10.284.CrossRefGoogle Scholar
  42. 42.
    Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987;136(1):58–61.  https://doi.org/10.1164/ajrccm/136.1.58.CrossRefPubMedGoogle Scholar
  43. 43.
    Strieder M, Pecherstorfer M, Kreye G. Symptomatic treatment of dyspnea in advanced cancer patients: a narrative review of the current literature. Wien Med Wochenschr. 2018;168(13–14):333–43.  https://doi.org/10.1007/s10354-017-0600-4.CrossRefPubMedGoogle Scholar
  44. 44.
    Vargas-Bermudez A, Cardenal F, Porta-Sales J. Opioids for the management of dyspnea in cancer patients: evidence of the last 15 years--a systematic review. J Pain Palliat Care Pharmacother. 2015;29(4):341–52.  https://doi.org/10.3109/15360288.2015.1082005.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Gomutbutra P, O'Riordan DL, Pantilat SZ. Management of moderate-to-severe dyspnea in hospitalized patients receiving palliative care. J Pain Symptom Manag. 2013;45(5):885–91.  https://doi.org/10.1016/j.jpainsymman.2012.05.004.CrossRefGoogle Scholar
  46. 46.
    Yennurajalingam S, Frisbee-Hume S, Palmer JL, Delgado-Guay MO, Bull J, Phan AT, et al. Reduction of cancer-related fatigue with dexamethasone: a double-blind, randomized, placebo-controlled trial in patients with advanced cancer. J Clin Oncol. 2013;31(25):3076–82.  https://doi.org/10.1200/jco.2012.44.4661.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Arends J, Bachmann P, Baracos V, Barthelemy N, Bertz H, Bozzetti F, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017;36(1):11–48.  https://doi.org/10.1016/j.clnu.2016.07.015.CrossRefPubMedGoogle Scholar
  48. 48.
    Dewys WD, Begg C, Lavin PT, Band PR, Bennett JM, Bertino JR, et al. Prognostic effect of weight loss prior to chemotherapy in cancer patients. Eastern Cooperative Oncology Group. Am J Med. 1980;69(4):491–7.CrossRefGoogle Scholar
  49. 49.
    Del Fabbro E. Current and future care of patients with the cancer anorexia-cachexia syndrome. Am Soc Clin Oncol Educ Book. 2015;35:e229–37.  https://doi.org/10.14694/EdBook_AM.2015.35.e229.CrossRefGoogle Scholar
  50. 50.
    Inui A. Cancer anorexia-cachexia syndrome: current issues in research and management. CA Cancer J Clin. 2002;52(2):72–91.CrossRefGoogle Scholar
  51. 51.
    Wie GA, Cho YA, Kim SY, Kim SM, Bae JM, Joung H. Prevalence and risk factors of malnutrition among cancer patients according to tumor location and stage in the National Cancer Center in Korea. Nutrition. 2010;26(3):263–8.  https://doi.org/10.1016/j.nut.2009.04.013.CrossRefPubMedGoogle Scholar
  52. 52.
    Nicolini A, Ferrari P, Masoni MC, Fini M, Pagani S, Giampietro O, et al. Malnutrition, anorexia and cachexia in cancer patients: a mini-review on pathogenesis and treatment. Biomed Pharmacother. 2013;67(8):807–17.  https://doi.org/10.1016/j.biopha.2013.08.005.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Muliawati Y, Haroen H, Rotty LW. Cancer anorexia - cachexia syndrome. Acta Med Indones. 2012;44(2):154–62.PubMedGoogle Scholar
  54. 54.
    Yavuzsen T, Davis MP, Walsh D, LeGrand S, Lagman R. Systematic review of the treatment of cancer-associated anorexia and weight loss. J Clin Oncol. 2005;23(33):8500–11.  https://doi.org/10.1200/jco.2005.01.8010.CrossRefPubMedGoogle Scholar
  55. 55.
    Morita T, Tei Y, Inoue S. Impaired communication capacity and agitated delirium in the final week of terminally ill cancer patients: prevalence and identification of research focus. J Pain Symptom Manag. 2003;26(3):827–34.CrossRefGoogle Scholar
  56. 56.
    Plonk WM Jr, Arnold RM. Terminal care: the last weeks of life. J Palliat Med. 2005;8(5):1042–54.  https://doi.org/10.1089/jpm.2005.8.1042.CrossRefPubMedGoogle Scholar
  57. 57.
    Cherny N, Ripamonti C, Pereira J, Davis C, Fallon M, McQuay H, et al. Strategies to manage the adverse effects of oral morphine: an evidence-based report. J Clin Oncol. 2001;19(9):2542–54.  https://doi.org/10.1200/jco.2001.19.9.2542.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Hiroyuki Goto
    • 1
    Email author
  • Yoshio Kiyohara
    • 2
  • Masahisa Shindo
    • 3
  • Osamu Yamamoto
    • 1
  1. 1.Division of Dermatology, Department of Medicine of Sensory and Motor Organs, Faculty of MedicineTottori UniversityTottoriJapan
  2. 2.Derpartment of DermatologyShizuoka Cacer CenterNagaizumi-choJapan
  3. 3.Clinic of DermatologyNational Hospital Organization Hamada Medical CenterHamadaJapan

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