Skin may become sore or develop a rash as a reaction to cancer treatment. Some people may experience altered or reduced skin sensation (e.g. ‘tingling’ or ‘numbness’) due to nerve damage or neuropathy from direct nerve compression or from systemic anti-cancer drugs (e.g. chemotherapy).

Clinical nurse specialists, physiotherapists, podiatrists and occupational therapists at a registered and enhanced level use a range of testing techniques (e.g. light touch/pin-prick tests) to assess skin sensation and will work with people to implement management strategies (e.g. to minimise risks of injury from pressure or trauma to areas of reduced sensation). Where an area of skin has become very sensitive (‘hypersensitive’), therapists can also teach desensitisation strategies. Occupational therapists will assess for appropriate seating, cushions and mattresses to maintain minimise risk of injury due to pressure.

Referral to podiatry may be indicated for people with painful neuropathy, or where the ability to walk is impacted by skin or nail problems affecting the feet and lower limb. There are a number of skin conditions linked to cancer, such as hand-foot syndrome, which may impact on footwear or the ability to remain physically active and referral to a podiatrist is recommended. Podiatrists will assess gait (walking pattern), detect joint deformities and pressure areas on the feet and can provide appropriate customised orthotics and deflective pressure pads to reduce the risk of falls/injury, minimise skin and soft tissue breakdown and advise on products that can help with painful neuropathy symptoms. Podiatrists will also provide footwear assessment and advice.

Scar formation is a normal response to injury, including after surgery for cancer and can be distressing because of appearance (e.g. to the face and neck after head and neck cancer surgery). Scar tissue is also not as stretchy and compliant as normal tissue and may form adhesions (become stuck down) to surrounding anatomical structures resulting in loss of movement and pain. Referral to appropriate professionals to support this should be considered e.g. to physiotherapy for soft-tissue mobilisation or electrotherapy techniques or podiatrists for lower limb soft-tissue mobilisation, laser and therapeutic ultrasound.

Some cancer treatments can have a significant impact on the nails including changes in rate or shape of growth, risk of nail infections, nail thickening or separation of the nail from skin (‘onycholysis’). People having cancer treatment with a high risk of nail problems should be referred to a podiatrist for close monitoring and treatment of the nail conditions as indicated.