World Cancer Day is held every year on 4th February. It seeks to raise awareness of cancer and to encourage its prevention, detection and treatment. Multiple initiatives are run on World Cancer Day to show support for those affected by cancer.

The primary goal of World Cancer Day is to significantly reduce illness and death caused by cancer and is an opportunity to rally the international community to end the injustice of preventable suffering from cancer.

The theme ‘I am and I will’ will run for three years, offering a chance to create long-lasting impact by increasing public-facing exposure and engagement, more opportunities to build global awareness and impact-driven action.

How Cancer Chemotherapy Can Affect the Feet

If chemotherapy is part of your cancer treatment, be aware that side effects may include conditions that affect the feet. The two most frequent are hand-foot syndrome, also called palmar-plantar erythrodyesthesia (PPE) and chemotherapy-induced peripheral neuropathy (CIPN).

PPE

Hand-foot syndrome usually manifests as redness, swelling, and pain on the palms of the hands and/or the soles of the feet. Sometimes it is accompanied by blisters, peeling of the skin, and rashes. Less frequently, it may occur in other areas, including knees and elbows.

One of the primary concerns with hand-foot syndrome is the potential infection of peeling or cracking skin and open sores. Use antibiotic creams and cover any open wounds or exposed areas with bandages. Over-the-counter burn pads and bandages may also be helpful. If any indication of infection occurs, consult a physician immediately. Common signs of infection are redness and swelling around a sore, a warm feeling when touched, the presence of pus, and sometimes red streaks in the area near the sore.

For more information see: https://www.cancer.net/navigating-cancer-care/side-effects/hand-foot-syndrome-or-palmar-plantar-erythrodysesthesia for more information.

If you suspect that you have hand-foot syndrome as a result of chemotherapy, and especially if the discomfort and pain interfere with your ability to walk and/or use your hands normally, consult your oncologist, your primary care physician, or a podiatrist at Betafeet Podiatry ( www.betafeetpodiatry.co.uk ).

CIPN

Chemotherapy-induced peripheral neuropathy typically occurs when chemotherapy drugs circulating in the body damage the nerves.

CIPN may last for a limited amount of time, or it may be a long-term issue, depending on age, other medical conditions (such as diabetes), whether or not you are taking other medications, and the type, dosage and frequency of chemotherapy treatment. Exercise may be beneficial in managing symptoms of CIPN.

Chemotherapy drugs are effective because they kill fast-growing cancer cells; however, because they circulate throughout the body, they may affect normally functioning, healthy cells as well. Not everyone experiences side effects, and side effects can vary in severity. The most effective way of dealing with side effects like hand-foot syndrome and chemotherapy-induced peripheral neuropathy is to work with your medical team, and take steps to address any symptoms as soon as they arise.

For more information see: https://fightcolorectalcancer.org/blog/chemotherapy-induced-peripheral-neuropathy-cipn/.

Also see: https://www.betafeetpodiatry.co.uk/peripheral-arterial-disease.

Skin Cancers of the Feet

Skin cancer can develop anywhere on the body, including in the lower extremities. Skin cancers of the feet have several features in common. Most are painless, and often there is a history of recurrent cracking, bleeding, or ulceration. Frequently, individuals discover their skin cancer after unrelated ailments near the affected site.

We often view the sun's harmful rays as the primary cause of skin cancer; the condition is often found on parts of the body that receive the most sun exposure. Skin cancers of the feet, however, are more often related to viruses, exposure to chemicals, chronic inflammation or irritation, or inherited traits. Unfortunately, the skin of the feet is often overlooked during routine medical examinations, and for this reason, it important that the feet are checked regularly for abnormalities that might indicate evolving skin cancer.

Some of the most common cancers of the feet are:

Basal Cell Carcinoma

Basal cell carcinoma frequently is seen on sun-exposed skin surfaces. With feet being significantly less exposed to the sun, it occurs there less often. This form of skin cancer is one of the least aggressive cancers in the body. It will cause local damage but only rarely spreads beyond the skin. Basal cell cancers may appear as pearly white bumps or patches that may ooze or crust and look like an open sore. On the skin of the lower legs and feet, basal cell cancers often resemble non-cancerous skin tumours or benign ulcers.

Squamous Cell Carcinoma

Squamous cell carcinoma is the most common form of cancer on the skin of the feet. Most types of early squamous cell carcinoma are confined to the skin and do not spread. However, when advanced, some can become more aggressive and spread throughout the body. This form of cancer often begins as a small scaly bump or plaque, which may appear inflamed. Sometimes there is a history of recurrent cracking or bleeding. Occasionally it begins as a hard projecting callus-like lesion. Though squamous cell cancer is painless, it may be itchy. Squamous cell cancer may resemble a plantar wart, a fungal infection, eczema, an ulcer, or other common skin conditions of the foot.

Malignant Melanoma

Malignant melanoma is one of the deadliest skin cancers known. Non-surgical treatments are rarely effective, and many remain experimental. This type of skin cancer must be detected very early to ensure patient survival. Melanomas may occur on the skin of the feet and on occasion beneath a toenail. They are found both on the soles and on the top of the feet. As a melanoma grows and extends deeper into the skin, it becomes more serious and may spread through the body through the lymphatics and blood vessels.

When reggae superstar Bob Marley died in 1981 aged 36, all sorts of conspiracy theories abounded. Instead, the Jamaican singer, musician and songwriter died of melanoma.

It’s easy to see how he could have missed the warning signs. People with very fair skin are the ones most at risk for skin cancer. When a dark spot appeared under his toenail, Marley attributed it to a recent soccer injury. He probably never imagined it could be anything serious, but the spot turned out to be a form of skin cancer called acral lentiginous melanoma that often becomes aggressive because it is detected later than other melanomas.

If Marley’s cancer had been detected early, it could have been treated and even cured. Instead, his melanoma spread, or metastasised, to other areas of his body and tragically cut his life short. Advances in melanoma treatment today likely could have saved or extended his life.

We’ll be focusing a future blog on ethnicity and the feet from a podiatric perspective.

When to Visit Your Podiatrist

Podiatrists are uniquely trained as lower extremity specialists to recognise and treat abnormal conditions on the skin of the lower legs and feet. Skin cancers affecting the feet may have a very different appearance from those arising on the rest of the body. For this reason, a podiatrist's knowledge and clinical training is of extreme importance for patients for the early detection of both benign and malignant skin tumours.

Learn the ABCDEs of melanoma. If you notice a mole, bump, or patch on the skin that meets any of the following criteria, see your podiatrist immediately:

• Asymmetry - If the lesion is divided in half, the sides don't match.
• Borders - Borders look scalloped, uneven, or ragged.
• Colour - There may be more than one colour. These colours may have an uneven distribution.
• Diameter - The lesion is wider than 6 mm.
• Evolution – The lesion changes in size, shape or colour.

For many podiatry patients today, the risk of amputation remains high. It must be understood that amputation can often avoid further complications, poor quality of life and even death. With modern prosthetic and biomechanical advancements, amputation of digits, feet and limbs doesn’t require major lifestyle changes. Many patients can carry on with their everyday life with small and simple changes.

Please see the following web links for more information:

https://www.apma.org/Patients/FootHealth.cfm?ItemNumber=990

https://www.medicalnewstoday.com/articles/79115.php

https://www.nhs.uk/conditions/melanoma-skin-cancer/

https://en.wikipedia.org/wiki/Acral_lentiginous_melanoma

https://www.thoughtco.com/why-did-bob-marley-die-3552830