One of the most common side effects from external-beam radiation therapy treatments are skin reactions. Yet there is no uniformity in assessment or treatment among radiotherapy departments in the U.K., according to an article in the February issue of Radiography.
An online survey conducted by the Society and College of Radiographers (SoR) to evaluate clinical skin care practice in radiotherapy departments throughout the U.K. revealed that there was considerable variability in caring for the skin of cancer patients receiving treatment, with little adherence to published guidelines from either the National Health Service (NHS) or the SoR.
Moreover, more than two-thirds of survey respondents did not routinely assess and formally record the patient's skin condition prior to starting radiotherapy treatment, making it impossible to accurately measure the level of skin toxicity following treatment (Radiography, February 2012, Vol. 18:1, pp. 21-27).
A total of 67 radiotherapy department managers, representing all the radiotherapy departments in the U.K., were sent a survey of 61 questions about skin care assessment before, during, and following treatment; types of treatment for different skin toxicities; and use of guidelines and protocols. Fifty-four departments, or 81%, responded.
All departments stated that they provided verbal and written information to patients on how they should care for their skin, and most had skin care guidelines and protocols. However, lead author Rachel Harris, PhD, professional officer for research of the SoR, determined unfounded practices were still being used that did not always reflect the current best-practice evidence and national guidelines. Products to treat skin condition and treatments varied. No single clear practice was followed by the majority of survey respondents.
No assessments had been made by departments with respect to the cost-effectiveness of using creams and topical agents for erythema or dry desquamation. Only one assessment of a product used to treat moist desquamation had been made. An assessment of products being recommended, and determining their effectiveness, had not been done, and, in fact, seemed to have been completely overlooked, the authors noted. Nor did departments assess the effectiveness of differently priced products, whether expensive or very inexpensive.
The researchers also expressed concern that while more than three-fourths of the respondents reported that their hospital employed a tissue-viability nurse, very few collaborated with that person with respect to skin care treatment for their cancer patients.
As a result of the survey findings, the SoR made five recommendations:
- The College of Radiographers skin care guidelines published in 2000 must be revised because they are obsolete.
- Research should be undertaken into patient preferences and compliance with skin treatment recommendations so that this information can be used to help develop future guidelines.
- High-quality clinical trials are needed to investigate the outcomes of intervention for dry or most desquamation.
- All radiotherapy departments should implement pretreatment assessment, baseline assessment, and weekly reviews of skin condition of patients using a validated tool and process.
- Evaluation of care of cancer patients with respect to skin toxicities is needed following radiotherapy treatment.
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&fit=crop&h=100&q=70&w=100)
![Examples of ultrasound findings and techniques. (A) Images in a 39-year-old male patient with a mass in the left thigh. The mass is heterogeneous on the B-mode US image (compared with the patient in D) and showed increased microvascularity (superb microvascular imaging [SMI]) and shear-wave elastography (SWE) values. Undifferentiated pleomorphic sarcoma was diagnosed at biopsy (with pleomorphic rhabdomyosarcoma in surgical specimen). (B) Images in an 18-year-old male patient with a mass in the left leg. The mass is hypoechoic on the B-mode image, with no other findings suggestive of malignancy. The lesion is in contact with the cortex of the tibia, which is slightly irregular. CT revealed a doubtful anteromedial tibial erosion. The microvascular study demonstrated high vascularization, suggestive of malignancy. Periosteal Ewing sarcoma was diagnosed with both histologic and immunohistochemical confirmation. (C) Images in a 69-year-old female patient with a lump growing on the outside of the left leg. Multiple SWE examinations were performed (please note the high values obtained in the measurements, whereas the color map highlights the stiffness relative to adjacent tissues). SMI showed areas of increased vascularization to target for sampling. Undifferentiated spindle cell sarcoma was diagnosed at biopsy, with residual leiomyosarcoma in the surgical specimen after neoadjuvant therapy. (D) Images in a 56-year-old female patient with a mass in the right thigh. The mass is heterogeneous at both B-mode ultrasound (similar to patient A) and MRI (coronal T2-weighted spectral attenuated inversion recovery [SPAIR]; T1-weighted pre-contrast and postcontrast imaging), which even shows uptake after the administration of paramagnetic contrast material, which is traditionally suggestive of malignancy. Low values at SMI and elastography are suggestive of benignity. Spindle cell lipoma was diagnosed at biopsy, with atypical spindle cell lipomatous tumor in the surgical specimen.](https://img.auntminnieeurope.com/mindful/smg/workspaces/default/uploads/2026/08/images-radiol250278fig2.APCFLSvX6p.jpg?auto=format%2Ccompress&dpr=2&fit=crop&h=167&q=70&w=250)
