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Head and Neck Cancer

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Book cover Skin Care in Radiation Oncology

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Abstract

Skin reactions are considered among the dose-limiting toxicities of radiation treatment for head and neck cancer (HNC), and these effects have a major impact on the level of acute pain and the duration of recovery experienced by the patient during the treatment course. Moreover, it is probable that the true impact of skin toxicity has been underestimated in prospective studies due to the relative insensitivity and non-specificity of the commonly used grading scales.

The usual course of HNC radiation-induced skin toxicity begins with erythema, followed by dry desquamation, hyperpigmentation, and then sometimes moist desquamation and necrosis of underlying soft tissues. Acute skin reactions may predispose for an increased risk of late toxicity, which can include aging of skin, alopecia, telangiectasia, superficial fibrosis, and changes in pigmentation.

Patient-related factors affecting acute skin toxicity can include age, nutrition, ethnicity, coexisting rheumatologic or other chronic medical conditions, obesity, and prior UV damage or reirradiation. Treatment-related factors can include location and volume of irradiated tissue, dose and fraction size, surgery, and interaction with systemic therapy.

Early prevention of reactions in intact skin is based on the dual principles of maintenance of skin integrity and protection of the skin from trauma or environmental stress or exposure. Management of dry desquamation can include the use of moisturizing emollient, as well as manual, enzymatic, or autolytic debridement. Management of moist desquamation can include daily debridement and wound cleansing, topical dressings, prevention of infection, and promotion of a wound-healing environment with optimal moisture level.

Re-epithelization should occur within 2 weeks after the last dose of radiation. Healing can be impaired by poor nutrition, concomitant medications, infection, or compromised vascularity resulting from hypertension, diabetes, or smoking.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero Street, Suite H1031, Box 1708, San Francisco, CA, 94143, USA

    Sue S. Yom MD, PhD, Florence Yuen RN, MSN, AOCNP & Joyce Tang RN, MN

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  1. Sue S. Yom MD, PhD
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  2. Florence Yuen RN, MSN, AOCNP
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Correspondence to Sue S. Yom MD, PhD .

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Editors and Affiliations

  1. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Barbara Fowble

  2. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Sue S. Yom

  3. Department of Radiation Oncology, University of California San Francisco, San Francisco, California, USA

    Florence Yuen

  4. Department of Dermatology, University of California San Francisco, San Francisco, California, USA

    Sarah Arron

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Yom, S.S., Yuen, F., Tang, J. (2016). Head and Neck Cancer. In: Fowble, B., Yom, S., Yuen, F., Arron, S. (eds) Skin Care in Radiation Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-31460-0_5

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  • Print ISBN: 978-3-319-31458-7

  • Online ISBN: 978-3-319-31460-0

  • eBook Packages: MedicineMedicine (R0)

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