LIVING WITH BASAL CELL CARCINOMA:
DEALING WITH THE SIDE EFFECTS OF TREATMENT

Surgery

Surgery carries both short- and long-term risks. This section will not cover short-term side effects of surgery such as bleeding, adverse reactions to medications, or difficulty closing the wound, because these are associated with the immediate surgical event, and your doctor will likely give you information after surgery addressing these issues.

Surgery can affect different body systems. Sensory nerve damage can occur with surgery, leading to localized numbness, a sensation of pins and needles, or burning or severe pain. Motor nerve damage can also occur, resulting in weakness or paralysis. In general, if the involved area is small, nerve damage may improve or resolve in approximately 12 months. However, sometimes the neurologic symptoms remain. Another intermediate- to longer-term complication that can occur after surgery is wound infection. The wound can also break down, or healing can be delayed. It’s important to keep your follow-up appointments with your surgery team and report any side effects immediately. Team members can offer strategies to address some of these complications.

Lymphedema (lim·fuh·dee·muh) is an accumulation of lymph in the soft tissue (swelling) caused by the damage/removal of lymph nodes/lymphatic channels. It can occur either short term or long term for patients with BCC who have had more extensive surgery. A lymphedema therapist can help with skin care, massage, bandaging, exercises, or a compression garment. This treatment is called complex decongestive therapy (CDT). For more about specific lymphedema management, see the “Treating Lymphedema” section of the American Cancer Society website: https://www.cancer.org/treatment/treatments-and-side-effects/physical-side-effects/lymphedema/for-people-with-lymphedema.html

One of the biggest challenges with advanced BCC (beyond the threat of poor overall outcomes) is the potential for unsightly cosmetic results. This can include loss or darkening of skin color, suture marks, or excessive scarring. When the BCC is highly invasive, the degree of disfigurement can be substantial. Having a good reconstruction plan and follow-up with you surgeon is important. In one study, squamous cell skin cancer patients reported reduced quality of life one month after surgery because of pain, functional challenges, and cosmetic challenges. Importantly, this response improved over the course of the year after surgery. However, for patients with disfigurement, an aggressive plan for reconstruction and emotional support and counseling can be very important.  Look in our RESOURCES  section for support groups and resources specifically available to help patients address the cosmetic impact of cancer and the emotional aspects of a change in your appearance.

Effects of Radiation Therapy

Side effects of radiation are usually restricted to the area that has been radiated and can include:

• Irritation of skin, ranging from redness to blistering and peeling
• Changes in skin color
• Loss of hair in the area being treated
• A long-term increase in new skin cancers in the area treated with radiation
• Damage to the salivary glands and teeth when treating cancers near the mouth
• Fatigue, taste changes, difficulty swallowing, and a less active thyroid gland (usually associated with radiation to the head and neck)

It’s important to talk with your radiology team about strategies to deal with these side effects. Some self-care approaches you can take include:

• Getting plenty of rest and establishing a good sleep routine
• Eating a balanced, nutrient-rich diet
• Taking care of the skin in the area that has received radiation. Be particularly careful to protect it from the sun, heat, and cold
• Avoiding irritating the skin by wearing tight or restrictive clothing

Effects of Immunotherapy

Immune checkpoint inhibitors such as cemiplimab and pembrolizumab rev up the immune system and cause a range of side effects. These can be considered autoimmune in nature. The figure below shows the body systems that can be involved.

Concerning side effects associated with immunotherapy are lung, liver, skin, neurologic, cardiac, and ocular problems; gastrointestinal inflammation; and hormonal problems affecting glands like the adrenal, pituitary, thyroid glands, and the pancreas. Serious side effects occurred in approximately one quarter or less patients in immunotherapy clinical trials.

With immunotherapy, reducing the dosage is not generally recommended. The management of these side effects typically involves stopping immunotherapy and then managing the side effect. In many of the moderate cases, corticosteroids are used to quiet the immune system, after which immunotherapy can be restarted. But in severe cases, the drug may need to be discontinued.

Below, please find a downloadable document for cemiplimab which can help you to recognize symptoms and work with your provider to manage your side effects. Please consider bringing these pages to your next appointment.

• LIBTAYO® (cemiplimab)

Effects of Hedgehog Inhibitors

There are a range of side effects associated with hedgehog inhibitors.

The most important side effect to be considered with hedgehog inhibitors is embryo-fetal toxicity, which means that these drugs can cause severe birth defects or fetal death. Importantly:

• Women with reproductive potential should use effective contraception during treatment with either sonidegib or vismodegib during therapy and for 20 months after the last dose of sonidegib and 24 months after the last dose of vismodegib
• Since these drugs can also be found in semen, men should use condoms to avoid potential drug exposure to pregnant partners or female partners with reproductive potential during therapy and for eight months after the last dose of sonidegib and three months after the final dose of vismodegib

Here are some of the more common side effects of hedgehog inhibitors as well as strategies you can employ to deal with them: