Dermatologic Principles and Practice in Oncology E-Book

Mario E. Lacouture

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1209

Veröffentlichungsjahr: 2013

Beschreibung

The first book focusing specifically on frequent and frequently disabling side effects involving the skin, hair and nails in cancer patients

According to the World Health Organization, there are approximately thirty million people living with a diagnosis of cancer – the majority of whom will receive surgery, systemic therapy, and/or radiation, and who will suffer from dermatologic adverse events. Dermatologists and oncologists are only beginning to grapple with these events, which pose serious quality-of-life issues with so many patients, and will become more prevalent as survival rates improve, thanks in part to new cancer treatments and drug regimens.

Concentrating on a topic that has only been briefly touched upon by other texts, this book offers a focused perspective on the clinical presentation, underlying pathophysiologic mechanisms, and management of skin, hair, and nail conditions for oncologists, dermatologists, and allied practitioners.
Dermatologic Principles and Practice in Oncology: Conditions of the Skin, Hair, and Nails in Cancer Patients:

• Covers in detail the dermatologic adverse events of oncologic therapies, clinical presentations, and treatment recommendations

• Enables dermatologists and other practitioners to significantly improve the care of patients with cancer
• Addresses the dermatologic adverse events of cancer therapies used globally, of which a large number are found in developing countries

• Emphasizes prophylactic measures – based on treatments used and type of cancer – to prevent the appearance of adverse events

• Provides built-in discussions on patient education for practical counseling during therapies

• Offers rapid-reference sections on topical dermatology drugs

The first book to present dermatologic conditions in cancer patients and survivors in a uniform and in-depth manner, Dermatologic Principles and Practice in Oncology is ideal for oncologists, oncology nurses, and dermatologists who wish to take better care of those with adverse skin, hair, and nail conditions.

Leseprobe

Table of Contents

Title page

Copyright page

List of Contributors

Preface

Acknowledgment

1: Dermatology and Oncology

1: Epidemiology and Burden of Disease

Introduction

Dermatologic health in cancer patients and survivors

Financial burden

Health-related quality of life

Dosing of chemotherapy

Conclusions

Appendix 1.1 Anticancer agents and associated adverse events affecting the skin, mucosa, hair, and nails. Based on data from Litt JZ, 2009 [8].

2: The History of Supportive Oncodermatology

Evolution of anticancer therapeutics

Spectrum of dermatologic adverse events stemming from conventional cytotoxic chemotherapy agents

Radiation and surgery-induced mucocutaneous toxicities

Mucocutaneous toxicities induced by novel targeted agents

Emergence of supportive oncodermatology and future directions

3: Structure and Function of the Integumentary System and the Dermatology Lexicon

Introduction

Skin

Appendages

Hair

Nails

Morphology

Raised lesions

Depressed lesions

Flat lesions

Fluid-filled lesions

Surface changes

Purpura and vascular lesions

Shape, configuration, arrangement, and distribution of lesions

Conclusions

4: Types of Dermatologic Reactions

Exanthematous eruptions

Urticarial eruptions

Lichenoid eruptions

Acneiform eruptions

Pustular eruptions (acute generalized exanthematous pustulosis)

Bullous eruptions

Drug-induced vasculitis

Erythroderma

Approach to patients with suspected drug eruption

Conclusions

5: Grading Dermatologic Adverse Events in Clinical Trials Using CTCAE v4.0

Common Terminology Criteria for Adverse Events

CTCAE grade scale

Changes in CTCAE V4.0

Refined grading to correlate with clinical management

Split of embedded terms

New adverse events

Moved to different SOC

CTCAE vs. MESTT

Conclusions

Appendix 5.1 Refined grading to correlate with clinical presentation and management.

Appendix 5.2 New adverse events in CTCAE v4.0 for the Skin and subcutaneous tissue disorders section.

6: Psychosocial Issues in Oncology: Clinical Management of Psychosocial Distress, Health-Related Quality of Life, and Special Considerations in Dermatologic Oncology

Psychosocial distress

Distress among dermatologic samples

Dermatologic AEs from cancer treatment

Risk factors for distress

Clinical management of distress

Measuring distress and health-related quality of life in dermatologic oncology

Psychosocial interventions in oncodermatology

Conclusions

7: Dermatopathology

Introduction

Mucocutaneous neoplasms

Inflammatory dermatoses

Conclusions

2: Cancer-Related Dermatologic Disorders

8: Paraneoplastic, Inherited Cancer Syndrome, and Environmental Carcinogen-Related Dermatoses

Paraneoplastic disorders

Inherited syndromes with increased cancer risk and skin effects

Environmental carcinogens with increased cancer risk and skin effects

3: Dermatologic Conditions During Cancer Therapy

9: Oral Mucosal Complications of Cancer Therapy

Introduction

Mucosal injury attributable to cytotoxic therapy

Clinical features and course of mucositis

Mucositis scoring

Impact of mucositis

Pathobiology of mucositis

Risk factors for mucositis

The oral environment and mucositis

Status of the development of therapies for mucositis

Mucosal changes associated with targeted therapies

Conclusions

10: Hair Disorders Associated with Anticancer Agents

Introduction

Basic hair anatomy and function

Types of chemotherapy-induced hair loss/alopecia

Permanent chemotherapy-induced alopecia

Grading scales utilized for determining degree of hair loss or regrowth

Potential treatments for chemotherapy-induced alopecia

Conclusions

11: Nail Abnormalities in Oncology Practice

Introduction

Drugs

Symptoms

Classification

Treatment

Prevention

Conclusions

12: Pruritus

Introduction

Clinical findings

Management

Physical treatments

Bio-behavioral therapy

Conclusions

13: Management Options for Hot Flashes in Cancer Patients

Introduction

Grading of hot flashes

Treatment of hot flashes

Conclusions and recommendations

4: Skin Toxicities to Chemotherapy

14: Alkylating Agents

Introduction

Nitrogen mustards

Aziridines and epoxides

Alkyl sulfonates

Nitrosoureas

Hydrazines and triazine derivatives

Hydroxurea

15: Antimetabolite Reactions

Introduction

Methotrexate

Pemetrexed

Capecitabine

Cytarabine

Gemcitabine

Mercaptopurine

Thioguanine

Fludarabine

Cladribine

16: Topoisomerase-Interacting Agents

Introduction

Topoisomerase I inhibitors

Topoisomerase II inhibitors

Alopecia

Hand-foot syndrome

Hyperpigmentation

Intertrigo

Nail changes

Extravasation of topoisomerase inhibitors

Stevens–Johnson syndrome

Mucositis

Radiation recall

Appendix 16.1 Dermatologic adverse event of topoisomerase inhibitors.

17: Epidermal Growth Factor Receptor Inhibitor Reactions

Introduction

Epidermal growth factor receptor inhibitors

Dermatologic adverse events of EGFRIs

Interaction of EGFRIs with conventional cytotoxic chemotherapy and radiotherapy

Conclusions

18: Small Molecule Multikinase Inhibitors

Introduction

Kit, PDGFR and bcr-abl inhibitors: imatinib, nilotinib, dasatinib

Antiangiogenic agents: sorafenib, sunitinib axitinib, regorafenib, and pazopanib

mTOR inhibitors: everolimus and temsirolimus

Conclusions

19: Antimicrotubule Agents

Introduction

Taxanes

Vinca alkaloids

Estramustine phosphate sodium

20: Histone Deacetylase Inhibitors, Proteasome Inhibitors, Demethylating Agents, Arsenicals, and Retinoids

Histone deacetylase inhibitors

Proteasome inhibitors

Demethylating agents

Arsenicals

Retinoids

21: Miscellaneous Reactions

Introduction

l-Asparaginase

Bleomycin

Thalidomide

Lenalidomide

Appendix 21.1 Incidence of dermatologic adverse events to miscellaneous agents (l-asparaginase, bleomycin, thalidomide, lenalidomide).

22: Skin Toxicities due to Biotherapy

Interferon α

Interleukins

Appendix 22.1 Incidence of dermatologic adverse events to biotherapies (interferon-a2a, interferon-a2b, interleukin 2).

23: Monoclonal Antibodies

Introduction

Effects linked to the nature of the mAbs

AEs caused by the function of the mAb

Anti-CTLA-4 antibody: Ipilimumab

Conclusions

24: Endocrine Agents

Introduction

Selective estrogen receptor modulators

Estrogen receptor downregulators

Aromatase inhibitors

Luteinizing hormone-releasing hormone agonist

Antiandrogens

Androgens

Estrogen

Progestational agents

Somatostatin analog

Conclusions

Appendix 24.1 Incidence of dermatologic adverse events to endocrine therapies.

25: Agents for the Management of Hematologic Reactions

Introduction

Erythropoietic growth factors: epotein alfa and darbopoetin alfa

Granulocyte colony-stimulating factors and granulocyte–macrophage colony-stimulating factors

Platelet growth factors

Anticoagulation agents

26: Radiation-Induced Skin Reactions

Introduction

Clinical features and pathophysiology

Modulating factors for acute radiation dermatitis

Management

Prevention

Systemic therapy

Treatment

Conclusions

Appendix 26.1 Summary of prophylactic and treatment randomized trials.

27: Hematopoietic Stem Cell Transplantation and Graft Versus Host Disease

Introduction

Indications for and methods of hematopoietic stem cell transplantation

Complications of HSCT

28: Extravasation Reactions

Introduction

Risk factors

Clinical features

Pathophysiology and dermatopathology

Treatment

Antidotes in chemotherapeutic drug extravasations

Aftercare

29: Topical Anticancer Therapies

Topical chemotherapy

Retinoids

Biologic response modifiers

Corticosteroids

Conclusions

30: Life-threatening (Serious) Dermatologic Adverse Events

Stevens–Johnson syndrome and toxic epidermal necrolysis

Hypersensitivity reactions

Drug rash with eosinophilia and systemic symptoms

Conclusions

31: Dermatologic Infections

Introduction

Bacterial infections

Fungal infections

Viral infections

Parasitic infections

Infections attributable to specific anticancer treatment modalities or their sequelae

Conclusions

Appendix 31.1 Recommendations for treatment of specific microorganisms.

5: Late Cutaneous Events from Cancer Treatment

32: Late Dermatologic Conditions

Introduction

Secondary skin neoplasms

Cutaneous metastases

Chronic radiation dermatitis and other cutaneous radiation effects

6: Dermatologic Practice in Oncology

33: Management Algorithms for Dermatologic Adverse Events

34: Dermatologic Therapeutics and Formulations

Introduction

Moisturizing therapy

Keratolytic therapy

Sunscreens

Insect repellants

Local anesthetic and analgesic therapy

Antiviral therapy

Antifungal therapy

Steroid therapy

Antipruritic therapy

Retinoid therapy

35: Dermatologic Techniques and Procedures

Introduction

Preoperative evaluation

Antiseptics

Local anesthetic and technique

Hemostasis

Wound dressings

Skin biopsy

Nail plate avulsion and chemical cauterization

Skin cultures

Diagnosis of fungal infection

Atypical mycobacterial and deep fungal culture

Management of common cutaneous neoplasms

Conclusions

Acknowledgments

36: Appearance-Related Concerns in the Cancer Patient

Introduction

Scarring from cancer-related surgery

Radiation tattoos

Areola tattoos

Hypertrichosis resulting from epidermal growth factor receptor inhibitors

Sensitive skin from chemotherapy

Bruising (purpura)

Radiation-induced telangiectasias

Hyperpigmentation from therapy

Conclusions

Index

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Published simultaneously in Canada

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Library of Congress Cataloging-in-Publication Data

Dermatologic principles and practice in oncology : conditions of the skin, hair, and nails in cancer patients / [edited by] Mario E. Lacouture.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-0-470-62188-2 (hardback : alk. paper) – ISBN 978-1-118-59060-7 – ISBN 978-1-118-59061-4 – ISBN 978-1-118-59062-1 – ISBN 978-1-118-59063-8

I. Lacouture, Mario E.

[DNLM: 1. Skin Diseases–etiology. 2. Skin Diseases–psychology. 3. Antineoplastic Agents–adverse events. 4. Neoplasms–complications. 5. Skin Care–nursing. 6. Skin Manifestations. WR 140]

RC280.S5

616.99'477–dc23

2013013054

Cover image: © authors and editor, middle image: istockphoto.com

Cover design by Matt Kuhns

List of Contributors

Asha Acharya PhD

Technical Resources International, Inc.

Bethesda, MD, USA

Najla Al-Dawsari MD, FAAD

Consultant Dermatologist

Dhahran Health Center

Saudi Aramco Medical Service Organization

Saudi Arabia

Raed O. Alhusayen MBBS, MSCE, FRCPC

Clinical Associate

Division of Dermatology

Sunnybrook Health Sciences Centre

Toronto, Canada

Iris Amitay-Laish MD

Dermatologist

Department of Dermatology

Rabin Medical Center, Beilinson Hospital

Petah Tikva, Israel

Milan J. Anadkat MD

Associate Professor

Division of Dermatology

Center for Advanced Medicine

Washington University School of Medicine

St. Louis, MO, USA

Yevgeniy Balagula MD

Clinical Research Fellow

Dermatology Service

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Robert Baran MD

Honorary Professor of the University of Franche-Comté

Nail Disease Center

Cannes, France;

Consultant Dermatologist

Cancer Institute Gustave Roussy

Villejuif, France

Christine B. Boers-Doets MSc

Department of Clinical Oncology

Leiden University Medical Center

Leiden, The Netherlands

Judy H. Borovicka MD

Clinical Research Fellow

Northwestern University Feinberg School of Medicine

Chicago, IL, USA

Jeffrey P. Callen MD

Professor of Medicine (Dermatology)

Chief, Division of Dermatology

University of Louisville School of Medicine

Louisville, KY, USA

David Cella PhD

Professor and Chair, Department of Medical Social Sciences

Northwestern University Feinberg School of Medicine

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Chicago, IL, USA

Alice Chen MD, FACP

Senior Investigator

Cancer Therapy Evaluation Program

National Cancer Institute

Rockville, MD, USA

Jennifer Nam Choi MD

Assistant Professor, Department of Dermatology,

Yale University School of Medicine

New Haven, CT, USA

Emily Y. Chu MD, PhD

Staff Clinician

Dermatology Branch, Center for Cancer Research

National Cancer Institute, National Institutes of Health

Bethesda, MD, USA

Kathryn T. Ciccolini RN, BSN, OCN

Office Practice Nurse

Dermatology Service

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Jonathan Cotliar MD

Associate Professor

Departments of Dermatology and Medicine

Robert H. Lurie Comprehensive Cancer Center

Northwestern University Feinberg School of Medicine

Chicago, IL, USA

Amy J. Derick MD

Clinical Instructor of Dermatology

Northwestern University Feinberg School of Medicine

Chicago, IL, USA;

Derick Dermatology LLC

Barrington, IL, USA

Maura Dickler MD

Associate Member

Breast Cancer Medicine Service

Department of Medicine

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Reinhard Dummer MD

Vice-Chairman

Department of Dermatology

University Hospital Zurich

Zurich, Switzerland

Robert Eilers Jr. MD

Resident Physician

Department of Dermatology

University of Michigan

Ann Arbor, MI, USA

Bernard Fouilloux MD

Consultant Dermatologist (Oncology Section)

Hôpital Nord

Saint-Etienne, France

Francine Foss MD

Professor of Medicine and Dermatology

Yale University School of Medicine

New Haven, CT, USA

Consultant Dermatologist

Dhahran Health Center

Saudi Aramco Medical Service Organization

Saudi Arabia

Claus Garbe MD

Professor of Dermatology

Head, Division of Dermatooncology

Department of Dermatology

University Medical Center

Tuebingen, Germany

Amit Garg MD

Hofstra School of Medicine and North Shore-LIJ Health System

Manhasset, New York, USA

Jennifer R.S. Gordon MD

Clinical Research Fellow

Northwestern University Feinberg School of Medicine

Chicago, IL, USA

Emmy Graber MD

Assistant Professor of Dermatology;

Director, Cosmetic and Laser Center

Boston University School of Medicine

Boston, MA, USA

Ann Cameron Haley MMS, PA-C

Clinical Research Assistant

Northwestern University Feinberg School of Medicine

Chicago, ILUSA

Axel Hauschild MD

Department of Dermatology

University Hospital Schleswig-Holstein Campus

Kiel, Germany

Molly A. Hinshaw MD

Dermatopathologist

Troy and Associates, Brookfield, WI, USA;

Associate Clinical Professor of Dermatology

University of Wisconsin School of Medicine and Public Health

Wisconsin, WI, USA

Stephanie W. Hu MD

Dermatology Resident

Ronald O. Perelman Department of Dermatology

New York University School of Medicine

New York, NY, USA

James I. Ito MD

Professor and Chief

Division of Infectious Diseases

City of Hope Comprehensive Cancer Center

Duarte, CA, USA

Katharina C. Kaehler MD

Senior Consultant Dermatooncology

Department of Dermatology

University Hospital Schleswig-Holstein Campus

Kiel, Germany

Zahra Kassam MBBS, FRCR (UK), FRCP(C), MSc

Staff Radiation Oncologist

Stronach Regional Cancer Centre

Southlake Regional Health Centre;

Princess Margaret Cancer Center

Toronto, ON, Canada

Caroline C. Kim MD

Assistant Professor, Harvard Medical School;

Director, Pigmented Lesion Clinic;

Associate Director, Cutaneous Oncology Program, Department of Dermatology

Beth Israel Deaconess Medical Center

Boston, MA, USA

Sandra R. Knowles BScPhm

Assistant Professor

University of Toronto, Toronto, Canada;

Sunnybrook Health Sciences Centre

Toronto, Canada

Heidi H. Kong MD, MHSc

Investigator and Head, Clinical Research Section

Dermatology Branch, Center for Cancer Research

National Cancer Institute, National Institutes of Health

Bethesda, MD, USA

Mario E. Lacouture MD

Associate Member

Dermatology Service

Memorial Sloan-Kettering Cancer Center;

Associate Professor

Department of Dermatology

Cornell University

New York, NY, USA

Nicole E. Larsen

Northwestern University Feinberg School of Medicine

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Chicago, IL, USA

Seppo W. Langer MD, PhD

Head, Thoracic and Neuroendocrine Section

Department of Oncology

Copenhagen University Hospital – Rigshospitalet

Copenhagen, Denmark

Erica H. Lee MD

Assistant Attending

Dermatology Service

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Mee-young Lee MSN

Nurse Practitioner

Cutaneous Oncology Program

Department of Hematology Oncology

Beth Israel Deaconess Medical Center

Boston, MA, USA

Larissa Leister MD

Attending Physician

Department of Dermatology

University Hospital Essen

Essen, Germany

Elisabeth Livingstone MD

Attending Physician

Department of Dermatology

University Hospital Essen

Essen, Germany

Charles L. Loprinzi MD

Regis Professor of Breast Cancer Research

Mayo Clinic

Rochester, MN, USA

Katherine Szyfelbein Masterpol MD

Department of Dermatology

Assistant Professor in Dermatology

Boston University School of Medicine

Boston, MA, USA

Christine Mateus MD

Cancer Institute Gustave Roussy

Villejuif, France

Beth N. McLellan MD

Assistant Professor of Dermatology

The Ronald O. Perelman Department of Dermatology

New York University School of Medicine

New York, NY, USA

Roger von Moos MD

Associate Professor of Oncology

University of Zurich

Zurich, Switzerland

Amanda R. Moraska MD

Anesthesiology Institute

Cleveland Clinic

Cleveland, OH, USA

Patricia L. Myskowski MD

Attending Physician, Dermatology Service

Memorial Sloan-Kettering Cancer Center;

Professor of Dermatology

Weill Cornell Medical College

New York, NY, USA

Kishwer S. Nehal MD

Director of Mohs Surgery

Dermatology Service

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Elise A. Olsen MD

Professor of Dermatology and Medicine

Duke University Medical Center

Durham, NC, USA

Cindy England Owen MD

Assistant Professor of Medicine (Dermatology)

University of Louisville School of Medicine

Louisville, KY, USA

Devika Patel MD

Resident in Dermatology

Department of Dermatology

Henry Ford Hospital

Detroit, MI, USA

Tejesh Patel MD

Assistant Professor

Department of Dermatology

University of Tennessee Health Science Center

Memphis, TN, USA

Caroline Robert MD, PhD

Chief of Dermatology Department

Cancer Institute Gustave Roussy

Villejuif, France

Alyx Rosen MD

Clinical Research Fellow

Dermatology Service

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

Steven T. Rosen MD

Division of Hematology/Oncology

Northwestern University Feinberg School of Medicine;

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Chicago, IL, USA

Dirk Schadendorf MD

Full Professor of Dermatology, Director and Chair of Department of Dermatology

University Hospital Essen

Essen, Germany

Ann Setser

Setser Health Consulting LLC

Chesterfield, MO, USA

Neil H. Shear MD, FRCPC

Professor of Medicine (Dermatology, Clinical Pharmacology) and Pharmacology

University of Toronto

Toronto, Canada

Vincent Sibaud MD

Department of Oncodermatology and Clinical Research Unit

Claudius Regaud Institute

Cancer Comprehensive Center

Toulouse, France

Tomas Skacel MD, PhD

Lecturer in Oncology

1st Dept Medicine, 1st Medical Faculty

Charles University Prague

Czech Republic

Stephen T. Sonis DMD, DMSc

Senior Surgeon Brigham and Women's Hospital and the Dana-Farber Cancer Institute;

Clinical Professor of Oral Medicine

Harvard School of Dental Medicine

Boston, MA, USA

Shannon C. Trotter

Assistant Clinical Professor

Director, Pigmented Lesion Clinic

Division of Dermatology

Ohio State University

Columbus, OH, USA

James L. Troy MD

Clinical Professor of Dermatology and Director of Dermatopathology

Dermatology Medical College of Wisconsin

Milwaukee, WI, USA

Lynne I. Wagner PhD

Associate Professor

Department of Medical Social Sciences

Northwestern University Feinberg School of Medicine;

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Chicago, IL, USA

Dennis P. West PhD, FCCP, CIP

Professor in Dermatology and Pediatrics

Northwestern University Feinberg School of Medicine

Robert H. Lurie Comprehensive Cancer Center of Northwestern University

Chicago, IL, USA

Rebecca K.S. Wong MB, ChB, MSc, FRCP

Professor

Department of Radiation Oncology

University of Toronto, Princess Margaret Hospital

University Health Network

Toronto, Canada

Caroline Yeager AB

Department of Dermatology

Duke University Medical Center

Durham, NC, USA

Gil Yosipovitch MD

Professor of Dermatology Neurobiology and Anatomy

Wake Forest University Health Sciences

Winston-Salem, NC, USA

Lisa Zimmer MD

Senior Attending Physician

Department of Dermatology

University Hospital Essen

Essen, Germany

Preface

This book is intended for oncology, nursing, and dermatology students, educators, and practitioners. Any of the modalities used against cancer: surgery, radiation, medical therapies, or therapeutic transplants, may have an effect on skin and its appendages, which can not only affect quality of life, health, but may also impact cost and dose intensity of therapy, all of which may affect clinical outcome. Although the focus is mainly on dermatologic adverse events of medical therapy, the effects of radiation, transplants, and surgeries will also be explored, with an emphasis on accurate diagnosis and effective management. In addition, basic derma­tologic nomenclature, pathology, and adverse event grading will be included for readers who have not had these as part of their curriculum or training. As dermatologic conditions may appear before or after the diagnosis of cancer, paraneoplastic conditions that may herald an underlying malignancy, as well as late effects of therapy, respectively, are also described herein by leaders in the field.

The skin is the human body's largest organ, a self-renewing tissue whose functions include thermoregulation, sensation, immunity, fluid and organ preservation, and vitamin D synthesis. These various functions, along with its multiple layers and the formation of appendages, such as hair and nails, allows for a complexity that is nowhere more manifest than in the oncology setting. Contributing authors have a unique expertise in the diagnosis and treatment of dermatologic conditions in people living with cancer. This vast expertise will undoubtedly assist in mitigating the various untoward events that can affect cancer patients and survivors, both physically and psychosocially.

In order to make this book rapidly accessible whenever a patient presents with a dermatologic condition, chapters have principally been divided into the mechanism of action of medical therapies, when appropriate. In addition, cutaneous structures have also been taken into consideration, with a separate chapter for hair, nails, and mucosae. Basic dermatologic procedures and appearance-related interventions have also been included, to expand the therapeutic options that may improve the quality of life and cutaneous health of our patients. The ultimate goal of this book is to help optimize the treatment of cancer, by minimizing the effects of dermatologic conditions on quality of life and maximizing therapeutic consistency.

Acknowledgment

We are very grateful to cancer patients, survivors, and their families, who have generously donated their time, thoughts, and have allowed us to photograph and discuss their symptoms them at a difficult time in their lives. We are privileged to have participated in their care. We are grateful to the support staff who enable us to deliver care to people touched by cancer. And we thank the readers for allowing us to participate in the care and understanding of their patients' dermatologic conditions.

Mario E. Lacouture MD

Associate Member

Department of Medicine

Memorial Sloan-Kettering Cancer Center

New York, NY, USA

1

Dermatology and Oncology

1

Epidemiology and Burden of Disease

Beth N. McLellan1, Devika Patel2 and Mario E. Lacouture3,4

1The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, NY, USA

2Department of Dermatology, Henry Ford Hospital, Detroit, MI, USA

3Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

4Department of Dermatology, Cornell University, New York, NY, USA

Introduction

Due to recent advances in cancer therapies, patients are now living longer than ever before. For all diagnosed cancers, the 5-year relative survival has increased from 50% in 1975–1977 to 66% in 1996–2004 [1]. From 1990 to 2003, all-site cancer deaths in the United States decreased by 1% per year and these declines were especially pronounced for some of the most common malignancies including breast, prostate, colorectal, and lung cancers [2]. In the United States in 2009, there were 1 479 350 new cancers expected to be diagnosed [1], of which 52–87% were treated with surgery, 24–35% with chemotherapy, and 47–51% with radiation therapy (based on 2002 data for breast, lung, and colorectal cancers) [3]. Fifty to sixty thousand hematopoietic stem cell transplants are performed worldwide per year [4].

The large number of people being diagnosed with cancer in combination with increased survival rates have led to an increased number of patients living with a history of cancer, estimated to be 11.1 million in 2005 in the United States [1], of which 270 000 are survivors of pediatric cancers [5]. The increased number of patients living with and after cancer has revealed a number of dermatologic issues specific to this population: affecting cutane­ous health, causing a financial burden, decreasing health-related quality of life, and impairing consistent drug dosing.

Dermatologic health in cancer patients and survivors

The relationship between the skin, hair, and nails and internal malignancies is manifested in various ways and in all phases of a patient's experience with cancer (Figure 1.1) . Even before a diagnosis of cancer is made, the skin may be affected by genetic syndromes with an increased cancer risk, environmental carcinogens leading to both skin conditions and internal malignancies, or paraneoplastic syndromes. Before treatment begins, patients can be affected by a number of dermatologic problems, most commonly tinea pedis/onychomycosis, pruritus, and xerosis [6]. After the diagnosis of cancer is made, cancer treatments (systemic agents, radiation, therapeutic transplants, and surgeries) can result in a number of skin, hair, and nail adverse events (AEs) that develop either as a result of idiosyncratic reactions or as an effect on rapidly proliferating cells (of which the skin, hair, and nails are prototypical structures).