The Side-Effects of Treating Skin Cancer

What to expect after treatment for melanoma or basal cell carcinoma

Side Effects of Treatment

Doctors plan treatment to keep side effects to a minimum, but it is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes side effects.

The side effects of cancer treatment depend mainly on the type and extent of the treatment. Side effects may not be the same for everyone, and they may change from one treatment to the next. Doctors and nurses can explain the possible side effects of treatment, and they can help relieve symptoms that may occur during and after treatment.

Surgery

The side effects of surgery depend mainly on the size and location of the tumor and the extent of the operation. Although patients may be uncomfortable during the first few days after surgery, this pain can be controlled with medicine. People should feel free to discuss pain relief with the doctor or nurse. It is also common for patients to feel tired or weak for awhile. The length of time it takes to recover from an operation varies for each patient.

Scarring may also be a concern for some patients. To avoid causing large scars, doctors remove as little tissue as they can without increasing the chance of recurrence. In general, the scar from surgery to remove an early stage melanoma is a small line (often 1 to 2 inches long), and it fades with time. How noticeable the scar is depends on where the melanoma was located, how well the person heals, and whether the person develops raised scars called keloids. When a tumor is large and thick, more surrounding skin and other tissue (including muscle) are removed. Although skin grafts reduce scarring from the removal of large growths, these scars will still be quite noticeable.

Surgery to remove the lymph nodes from the underarm or groin may damage the lymphatic system and slow the flow of lymph in the arm or leg. Lymph may build up in a limb and cause swelling (lymphedema). The doctor or nurse can suggest exercises or other ways to reduce swelling if it becomes a problem. Also, it is harder for the body to fight infection in a limb after nearby lymph nodes have been removed, so the patient will need to protect the arm or leg from cuts, scratches, bruises, or burns that may lead to infection. If an infection does develop, the patient should see the doctor right away.

Chemotherapy

The side effects of chemotherapy depend mainly on the drugs and the doses received. In addition, as with other types of treatment, side effects vary from person to person. Generally, anticancer drugs affect cells that divide rapidly. In addition to cancer cells, these include blood cells, which fight infection, help the blood to clot, or carry oxygen to all parts of the body. When blood cells are affected, people are more likely to get infections, may bruise or bleed easily, and may feel unusually weak or tired. Cells in hair roots and cells that line the digestive tract also divide rapidly. As a result, people may lose their hair and may have other side effects, such as poor appetite, nausea and vomiting, or mouth and lip sores. These side effects generally go away gradually during the recovery periods between treatments or after treatment is over. The National Cancer Institute booklet Chemotherapy and You has helpful information about chemotherapy and coping with side effects.

Biological Therapy

The side effects caused by biological therapy vary with the type of treatment. These treatments may cause flu-like symptoms, such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients may also bleed or bruise easily, get a skin rash, or have swelling. These problems can be severe, but they go away after treatment stops.

Radiation Therapy

The side effects of radiation therapy depend on the amount of radiation given and the area being treated. Side effects that may occur during treatment include fatigue and hair loss in the treated area. Although the side effects of radiation therapy can be unpleasant, the doctor can usually treat or control them. It also helps to know that, in most cases, side effects are not permanent. The National Cancer Institute booklet Radiation Therapy and You has helpful information about radiation therapy and managing its side effects.

Nutrition for People with Cancer

Eating well during cancer treatment means getting enough calories and protein to help prevent weight loss and regain strength. This often helps people feel better and have more energy.

Some people with cancer find it hard to eat well because they may lose their appetite. In addition, common side effects of treatment, such as nausea, vomiting, or mouth sores, can make eating difficult. Often, foods taste different. Also, people being treated for cancer may not feel like eating when they are uncomfortable or tired.

Doctors, nurses, and dietitians can offer advice on how to get enough calories and protein during cancer treatment. Patients and their families also may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful suggestions.

Followup Care

Melanoma patients have a high risk of developing separate new melanomas. Some also are at risk for a recurrence of the original melanoma in nearby skin or in other parts of the body.

To increase the chance that a new melanoma will be detected as early as possible, patients should follow their doctor's schedule for regular checkups. It is especially important for patients who have dysplastic nevi and a family history of melanoma to have frequent checkups. Patients also should examine their skin monthly (keeping in mind the "ABCD" guidelines in the Signs and Symptoms of Melanoma section and the skin self-exam guide described in How to Do a Skin Self-Exam) and follow their doctor's advice about how to reduce their chance of developing another melanoma. General information about preventing melanoma is described in the Causes, Risk Factors, and Prevention section.

The chance of recurrence is greater for patients whose melanoma was thick or had spread to nearby tissue than for patients with very thin melanomas. Followup care for those who have a high risk of recurrence may include x-rays; blood tests; and scans of the chest, liver, bones, and brain.

Recovery and Outlook

It is natural for anyone facing cancer to be concerned about what the future holds. Understanding the nature of cancer and what to expect can help patients and their loved ones plan treatment, anticipate lifestyle changes, and make quality of life and financial decisions.

Cancer patients frequently ask their doctors, "What is my prognosis?" Prognosis is a prediction of the future course and outcome of a disease and an indication of the likelihood of recovery. When doctors discuss a patient's prognosis, they are attempting to project what is likely to occur for that individual patient.

Sometimes people use statistics they have heard to try to figure out their own chances of being cured. However, statistics reflect the experience of large groups of patients; they cannot be used to predict what will happen to a particular patient because no two patients are alike. The prognosis for a person with melanoma can be affected by many factors, particularly the stage of the cancer and the patient's general health and response to treatment. The doctor who is most familiar with the patient's situation is in the best position to help interpret statistics and discuss the patient's prognosis.

When doctors talk about surviving cancer, they may use the term remission rather than cure. Although many people with melanoma are successfully treated, doctors use this term because cancer can return. Many patients find it helpful to discuss the possibility of recurrence with the doctor.

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