After Leukemia, Dealing with Skin Cancer
Last updated: May 2020
Heading to my checkup the other day at the Dana-Farber Cancer Institute, I went up to the eighth floor, the one clearly marked for leukemia. So it might sound odd that when my nurse practitioner opened my chart, she said, “It’s all dermatology.”
But dermatology is mostly where I live now, 10 years after my fourth stem cell transplant. That’s because I have graft-versus-host disease (GVHD) of the skin. GVHD occurs “when the donor’s T cells (the graft) view the patient’s healthy cells (the host) as foreign, and attack and damage them,” according to the Leukemia and Lymphoma Society.1 If it’s acute, it can occur shortly after an allogeneic transplant. It can be life-threatening, but immune suppressant drugs given after transplant reduce the risk. It can also occur years later, as was the case with me.
Detour ahead: My experience with GVHD
I’m going to take a little detour, but I promise to get back to dermatology.
GVHD of the gut & liver
Skin, gut, and liver are the most common places for GVHD, and I have had all three. First I got GVHD of the gut. It caused chronic diarrhea – about three weeks worth ¬– and a state of misery to go with it. Everywhere I went, I had to run to the bathroom. My rear end was so sore that even constant applications of Desitin barely took the edge off.
I could have kissed the lovely gastroenterologist who said she would fast-track a colonoscopy. It revealed colitis. Luckily, a drug for colitis made it go away. I also had GVHD of the liver, controlled with prednisone.
GVHD of the skin
A few years after that – seven years post-transplant – I noticed that my abdomen was hardening as though I was either pregnant or carrying a bowling ball.
Around the same time, the skin on my thighs and stomach began to thicken and harden and develop little pockmarks and bubbles. I thought maybe it was cellulite, but my doctor said it was GVHD of the skin. To top it off, I got a decent-sized divot in my right thigh.
GVHD, stem cell transplants, and skin cancer risk
Usually, it happens earlier, but I like to do things differently. GVHD can suppress the immune system and open the transplant recipient up to greater skin cancer risk. Since transplants themselves also make recipients susceptible to squamous cell skin cancers in particular, people like me have an even higher risk of getting skin cancer.2
Three dermatology reports later
Hence my nurse practitioner found herself looking at reports from three dermatologists.
They were my primary one, my secondary one who specializes in subcutaneous dermatology (the layer beneath the skin), and the surgeon who had recently performed my umpteenth Mohs surgery. During this procedure, a surgeon removes skin cancer one layer at a time and examines it to make sure all the margins are clear.3 It means getting stitches that set me back a few weeks during which I am unable to play tennis or do other activities that I love. One recent week after surgery was especially bad, but it made getting the stitches out that much sweeter.
Some good news about GVHD and risk of relapse
The good news is that those with GVHD are less likely to relapse. The authors of an article in the American Journal of Clinical Dermatology explain: “In spite of all its negative consequences, GVHD is associated with a beneficial effect known as graft-versus-leukemia (GVL) and lower relapse rates of hematologic malignancies.”4
I didn’t have GVHD when I relapsed, and now that I have GVHD, I haven’t relapsed, so it helps to see all these problems in a positive light.
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