Neuropathy as a Side Effect of Skin Cancer Treatment

Neuropathy (nerve damage causing numbness, tingling, burning pain, or weakness) can occur with certain skin cancer treatments, but how common it is depends on the therapy used. Chemotherapy drugs known to injure nerves can cause peripheral neuropathy fairly frequently, while immune checkpoint inhibitors cause neurological side effects less often but can be serious, and surgery may cause local nerve injury depending on tumor location. ^[1] [PM18] ^[2]

How common is neuropathy?

• Chemotherapy-induced peripheral neuropathy (CIPN): Peripheral neuropathy is a common complication of several classes of anti‑cancer drugs; overall, about one‑third of patients exposed to multiple neurotoxic agents may experience it, with incidence varying by drug, dose, and duration. ^[1] Symptoms are typically “glove and stocking” sensory changes in fingers and toes that can progress with ongoing treatment. ^[3]

• Immune checkpoint inhibitors (e.g., anti‑PD‑1, anti‑CTLA‑4 used in melanoma): Neurologic immune‑related adverse events are less frequent than other toxicities, generally reported under 5% overall, and under 1% for many trial populations, but they can include peripheral neuropathies and other serious syndromes. [PM18] In melanoma experiences, cumulative neurotoxicity with these agents has been reported below 1% in trials, though real‑world presentations vary. [PM19]

• Surgery for skin cancer: Depending on the surgical site, local sensory or motor nerve injury can occur and may require prolonged observation for recovery. ^[2]

Which treatments are most linked to neuropathy?

• Taxanes (e.g., paclitaxel, docetaxel): Well‑known to cause CIPN; symptoms are predominantly sensory and often dose‑dependent. ^[1]

• Platinum agents (e.g., oxaliplatin, carboplatin): Can contribute to neuropathy and neuropathic pain syndromes. ^[4]

• Vinca alkaloids and other neurotoxic agents (e.g., vincristine, eribulin, ixabepilone): Recognized causes of CIPN. ^[4]

• Antibody–drug conjugates and proteasome inhibitors: Several targeted agents and ADCs have documented neuropathy risks; incidence and severity vary by agent and exposure. ^[1]

• Immune checkpoint inhibitors: Neuropathies are uncommon but may present as inflammatory neuropathies among other neurologic immune‑related events, often within weeks to months of therapy start. [PM18]

Risk factors

• Pre‑existing neuropathy, diabetes, alcohol use, smoking, prior neurotoxic drugs, and combined neurotoxic regimens can increase risk or severity. ^[5] Higher cumulative exposure often raises the chance of moderate to severe neuropathy and may necessitate dose adjustments. ^[6]

What does neuropathy feel like?

CIPN usually starts as symmetrical numbness, tingling, burning, or “pins and needles” in toes and fingers, sometimes progressing to hands and feet; balance problems and fine motor difficulties can occur with worsening severity. ^[3] Symptoms can begin after a few cycles and may improve after treatment ends, though recovery is variable. ^[6]

When to contact your care team

Report new tingling, numbness, burning pain, weakness, trouble with buttons or balance, or sudden neurologic changes. Early reporting allows dose adjustments or evaluation to prevent progression. ^[1] Severe or rapidly evolving symptoms during immunotherapy warrant urgent assessment for immune‑related neurologic events. [PM18]

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Management Strategies

1) Modify cancer treatment exposure

• Dose reduction, delay, or discontinuation of neurotoxic agents is commonly used when neuropathy reaches moderate to severe levels to prevent permanent damage. ^[1] Grade 3–4 neuropathy generally triggers holding treatment until improvement to Grade 1 in many protocols. ^[5]

2) Symptom‑focused medications

• Clinicians often use neuropathic pain agents such as duloxetine, gabapentinoids, or tricyclics to ease discomfort, tailored to individual tolerance and comorbidities. These aim to reduce pain and tingling rather than “cure” nerve injury. ^[7] Rehabilitative services can also prescribe medications and strategies to support function. ^{[8] [9]}

3) Rehabilitation and safety

• Physical and occupational therapy help maintain balance, strength, and daily function; fall‑prevention and hand/foot care are emphasized. ^[8] Therapy can be adapted to reduce interference with walking and fine motor tasks. ^[9]

4) Supportive self‑care

• Protect hands and feet from extreme temperatures; check skin daily to prevent injuries you may not feel; wear well‑fitting shoes; use assistive devices if balance is affected. ^[7] Avoid alcohol and smoking and optimize diabetes control, as these can worsen neuropathy. ^[5]

5) Immune‑related neuropathy approach

• If neuropathy occurs on immune checkpoint inhibitors, clinicians may evaluate for inflammatory neuropathies and start corticosteroids or other immunosuppression depending on severity and syndrome, while holding immunotherapy as indicated. [PM18] Standardized definitions and grading help guide treatment decisions and multidisciplinary coordination. [PM22]

6) Monitoring and expected course

• Time to onset can be within the first few months of neurotoxic chemotherapy, and many cases improve after therapy ends, though recovery varies by agent and severity. ^[6] Regular neurologic checks during treatment help catch changes early and adjust care before significant disability develops. ^[7]

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Practical Tips You Can Use

• Tell your team early about tingling or numbness; small changes matter. Early action can prevent worsening. ^[1]
• Keep a symptom diary noting onset, activities that worsen symptoms, and impact on sleep or function to guide treatment adjustments. ^[7]
• Balance and foot care: use night lights, remove tripping hazards, and consider a cane or balance exercises if unsteady. ^[8]
• Hand care: use padded grips, warm (not hot) water, and break tasks into shorter sessions to reduce strain. ^[9]

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Summary

Neuropathy is common with several chemotherapy drugs used for skin cancers and less common but potentially serious with immune checkpoint inhibitors, while surgery can cause localized nerve injury depending on site. ^[1] [PM18] ^[2] Management usually combines treatment dose adjustments, symptom‑relief medicines, rehabilitation, and safety strategies, with prompt evaluation for immune‑related causes when on immunotherapy. Early recognition and tailored care can reduce long‑term nerve damage and improve daily life. ^{[1] [8]} [PM18]

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