Supportive Oncodermatology: What the **** is that?

Featuring Adam Friedman, MD

Dr. Adam Friedman gave a lively introduction to oncodermatology this morning. As cancer mortality has gone down, survivors of cancer with perpetual skin issues has gone up. A 2008 statistic reveals that among adverse events from phase 1 and 2 trials, 8% of these are dermatologic complaints. Of interest, many of the chemotherapeutic and biologic targets that are overexpressed in cancer are also overexpressed in skin and nails. When quality of life in oncology patients has been studied, 67% of patients felt their dermatologic toxicities were worse than expected while 84% of these same patients were not referred to a dermatologist.
Dr. Friedman mentioned the cost of these side effects can be astronomical, though could be reduced if these patients were more proactively managed.

As cancer mortality has gone down, survivors of cancer with perpetual skin issues has gone up.

Next, Dr. Friedman discussed hand foot skin reactions (HFSR) which presents with hyperkeratotic painful plaques on hands and feet. This has been found commonly in patients who are undergoing treatment with multikinase inhibitors for colorectal cancers. Timing is typically 5 weeks into treatment and can be dose dependent. It is more common among female patients, patients with liver metastases and when 2 or more organs are involved with cancer. Treatment can include protection with padding or barriers, moisturizing, pain control, urea creams, topical steroids and anti-neuroleptics. While not ideal, dose reduction or a short vacation from the medication may be needed.

Dr. Friedman went on to discuss treatment with taxanes and its effect on hair and nails. Up to 44% of patients treated with taxanes will present with onycholysis. Some of these patents may present with a condition known as TAXANE induced PATEO or periarticular thenar erythema with onycholysis. Treatment of patients with onycholysis includes monitoring for infection, antibiotic therapy, diluted vinegar soaks, moisturizers, keeping the nails trimmed short and hand protection with gloves. While some patients improve after their treatment with the taxane is discontinued, 27% of patients will have persistent onycholysis. In addition to onycholysis, hair loss is common among taxane treated patients. Dr. Friedman conveyed that many female patients will have a great deal of cosmetic concern with eyebrow loss as it is an obvious “sign of cancer”.

Up to 44% of patients treated with taxanes will present with onycholysis.

Dr. Friedman also presented information regarding the presentation of cutaneous metastases.
He recommends biopsying anything that may be in close proximity to a primary tumor. These may be smooth or shiny dome shaped papules on presentation and usually biopsied easily with a punch biopsy. Unfortunately, survival rates of patients who present with cutaneous metastatic disease is typically less than one year. Additional topics that were presented by Dr. Friedman include papulopustular eruptions, EGFR inhibitors, skin cancer presentations in cancer patients, chemotherapy induced hair loss and BRAF inhibitors.