Sara Alcorn, MD, PhD, Crystal Aguh, MD

Developing a New Tool to Assess Skin Toxicity Across Skin Tones

Sara Alcorn, MD, PhD, and Crystal Aguh, MD, of the Johns Hopkins University School of Medicine are leading a team developing a web-based tool that will objectively assess acute skin toxicity in patients with a wide range of skin tones who are receiving radiotherapy to treat breast cancer. Up to 95% of patients receiving breast radiation therapy experience an acute skin reaction, but existing grading tools commonly used to determine the severity of the reaction tend to rely on subjective scoring by providers that could introduce bias and result in mischaracterization. For example, the two most popular scales utilized in this setting primarily define acute skin reaction as a rating of erythema, which is reddening of the skin and can be difficult to assess in people of color.

In this unique collaboration between the Department of Radiation Oncology and the Ethnic Skin Program in the Department of Dermatology, Dr. Alcorn and Dr. Aguh are creating a novel grading system based on images taken with a digital camera that are translated into colorimetric data. Colorimetry is a well-validated technique for detecting subtle changes in skin color characteristics. Prior work by the Department of Dermatology has shown that colorimetry can be used to detect changes in both pigment and erythema and may be particularly useful for assessing skin in people of color. In addition to employing this objective measure of skin change, the new tool will be the first to incorporate patient reported outcomes directly into the grading system, increasing its potential impact on quality of life from the patient’s perspective.

In their study, Dr. Alcorn, Dr. Aguh and their team are:

• Prospectively collecting provider ratings of acute skin reaction, patient reported outcomes and colorimetry data for patients receiving hypofractionated whole breast radiotherapy at baseline, every two weeks during treatment and two weeks after completion.
• Characterizing the relationships between the provider ratings, patient reported outcomes and colorimetry data to determine the best statistical model for assessing acute skin reaction.
• Building a photo-based web tool to objectively measure and grade acute skin reaction based on this model.
• Pilot testing the web tool to compare the acute skin reaction grades assigned by the tool versus the values collected in clinic.

With the award from the ROI, Dr. Alcorn and Dr. Aguh aim to create a better way to assess acute skin reactions using a tool that will be readily available and easy to apply in standard clinical practice and thus improve quality of life for patients across the range of skin tones.

Presentations

• Development of gRADient: An Inclusive Tool for Objective Measurement of Radiation Acute Skin Toxicity Across Skin Tones in Breast Cancer was presented at the 2022 ASTRO Annual Meeting.