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Skin cancer is the commonest second cancer after almost any treatment, and the commonest one left out of the counts, because registries record non-melanoma skin cancers inconsistently or not at all. Most are basal cell carcinomas, most are curable when treated, and the practical answer is to look at irradiated skin and to have anything that bleeds, crusts or does not heal in six weeks examined.
What to do about it. No country screens survivors' skin as a programme. What is offered instead is advice and access: knowing that skin inside an old radiotherapy field is the highest-risk area, protecting it from the sun, and having any new, changing or non-healing lesion looked at by a general practitioner or dermatologist. A survivor of transplant or on long-term immunosuppression has a different and larger risk, which belongs to the transplant facet of this round.
Why the numbers are unreliable, stated plainly. Basal cell carcinoma and cutaneous squamous cell carcinoma are the commonest cancers in fair-skinned populations and are either excluded from cancer registries or recorded only partially, including in SEER, which is the source of most second cancer statistics. The large cohort studies of second cancers after radiotherapy therefore count solid cancers while leaving out the commonest one. Any figure for how many survivors develop a skin cancer is an undercount, and this record would rather say that than reproduce a number whose denominator is wrong.
What is known about the radiation field. Radiation-associated keratinocyte cancers arise in irradiated skin, as the sarcomas do, and the relationship is positional in the same way. The corpus holds a record on second primary skin cancers after a first keratinocyte cancer, which is a different and much larger effect driven by ultraviolet damage across the whole exposed surface rather than by treatment; the record on field cancerisation explains why one skin cancer predicts the next. Both apply to survivors as they do to anyone else, on top of any radiotherapy effect.
The practical list. The lesions that warrant a look are a sore that does not heal within about six weeks, a lump that bleeds or crusts repeatedly, a scaly patch that persists, a mole that changes in size, shape or colour, and any new growth inside the borders of an old radiotherapy field, including inside a tattoo mark used for treatment set-up. Basal cell carcinoma, the commonest of these, grows slowly and is cured by local treatment in the great majority of cases; the reason to act early is that a small one is treated with a smaller operation.
The gap. There is no trial of skin surveillance in cancer survivors, no guideline that recommends it as a programme, and no measure of whether a yearly skin check in this group would find anything that mattered. That is the state of the evidence rather than a recommendation against looking.
Showing the technology this term belongs to: Survivorship care and late-effects surveillance.
Shares No randomised trial shows that any survivorship screening programme reduces death, Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure and the tags rejuvenation, survivorship, second-cancers, radiotherapy, screening.
Shares No randomised trial shows that any survivorship screening programme reduces death, Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure and the tags rejuvenation, survivorship, second-cancers, radiotherapy, screening.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, radiotherapy, screening.
Shares No randomised trial shows that any survivorship screening programme reduces death, Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure and the tags rejuvenation, survivorship, second-cancers, radiotherapy.
Shares No randomised trial shows that any survivorship screening programme reduces death, What is not a second cancer: recurrence, metastasis and field cancerisation, Second cancers after treatment: what the risk is, and what is done about it, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, screening.
Shares No randomised trial shows that any survivorship screening programme reduces death, Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, screening.
Shares Second cancers after radiotherapy, Second cancers after treatment: what the risk is, and what is done about it, Radiotherapy and second cancers: field, dose and age at exposure, Secondary malignancy (therapy-related cancer) and the tags rejuvenation, survivorship, second-cancers, radiotherapy.