Table 5.
MASCC Grading Tool for Skin Toxicities
| Adverse Event | Grade 1 | Grade 2 | Grade 3 | Grade 4 |
|---|---|---|---|---|
| Papulopustular eruption (Grading individually for face, scalp, chest or back) | 1A. Papules or pustules <5; OR 1 area of erythema or edema <1 cm in size | 2A. Papules or pustules 6–20; OR 2–5 areas of erythema or edema <1 cm in size | 3A. Papules or pustules >20; OR more than 5 areas of erythema or edema <1cm in size | - |
| 1B. Papules or pustules <5; OR 1 area of erythema or edema <1cm in size AND pain or pruritus | 2B. Papules or pustules 6–20; OR 2–5 areas of erythema or edema <1cm in size AND pain, pruritus, or effect on emotions or functioning | 3B. Papules or pustules >20; OR more than 5 areas of erythema or edema <1cm in size; AND pain, pruritus, or effect on emotions or functioning | - | |
| Nail changes -Nail Plate | Onycholysis or ridging without pain | Onycholysis with mild/moderate pain; any nail plate lesion interfering with instrumental ADL | Nail plate changes interfering with self-care ADL | - |
| Nail changes -Nail fold | Disruption or absence of cuticle; OR erythema | Erythematous/tender/painful; OR pyogenic granuloma; OR crusted lesions; OR any fold lesion interfering with instrumental AD | Periungual abscess: OR fold changes interfering with self-care ADL | - |
| Nail changes -Digit tip | Xerosis AND/OR erythema without pain | Xerosis AND/OR erythema with mild/moderate pain or stinging; OR fingertip fissures; OR any digit tip lesion interfering with instrumental ADL | Digit tip lesions interfering with self-care ADL | - |
| Erythema | Painless erythema, blanching; erythema covering <10% BSA | Painful erythema, blanching; erythema covering 10–30% BSA | Painful erythema, nonblanching; erythema covering >30% BSA | - |
| Pruritus | Mild OR localized, intermittent, not requiring therapy | 2A. Moderate localized OR widespread intermittent AND requiring intervention | Severe, widespread constant AND interfering with sleep | - |
| 2B. Moderate localized OR widespread constant AND requiring intervention | ||||
| Xerosis | Scaling/flaking covering <10% BSA NO erythema/pruritus/effect on emotions or functioning | 2A. Scaling/flaking covering 10–30% BSA + pruritus OR effect on emotions/functioning | 3A. Scaling/flaking covering >30% BSA AND pruritus AND erythema AND effect on emotions/functioning AND + fissuring/cracking | - |
| 2B. Scaling/flaking + pruritus covering 10–30% BSA AND effect on emotions/functioning + erythema | 3B. Scaling/flaking covering >30% BSA And pruritus AND erythema AND effect on emotions/functioning AND fissuring/cracking + signs of super infection | - | ||
| Hair changes: scalp hair loss or alopecia | Terminal hair loss <50% of normal for that individual that may or may not be noticeable to others but is associated with increased shedding and overall feeling of less volume. May require different hair style to cover but does not require hairpiece to camouflage | 2A. Hair loss associated with marked increase shedding and 50–74% loss compared to normal for that individual. Hair loss is apparent to others, may be difficult to camouflage with change in hair style and may require hairpiece | - | - |
| 2B. Marked loss of at least 75% hair compared to normal for that individual with inability to camouflage except with a full wig OR new cicatricial hair loss documented by biopsy that covers at least 5% scalp surface area. May impact on functioning in social, personal or professional situations | ||||
| Hair changes: disruption of normal hair growth (specify) – Facial hair (diffuse, not just in male beard/mustache areas), Eyelashes, Eyebrows, Body hair, Beard and mustache hair (hirsutism) | Some distortion of hair growth but does not cause symptoms or require intervention | 2A. Distortion of hair growth in many hairs in a given area that cause discomfort or symptoms that may require individual hairs to be removed | - | - |
| 2B. Distortion of hair growth of most hairs in a given area with symptoms or resultant problems requiring removal of multiple hairs | ||||
| Hair changes: increased hair growth (specify) – Facial hair (diffuse, not just in male beard/mustache areas), Eyelashes, Eyebrows, Body hair, Beard and moustache hair (hirsutism) | Increase in length thickness and/or density of hair that the patient is able to camouflage by periodic shaving, bleaching or removal of individual hairs | 2A. Increase in length, thickness and/or density of hairs that is very noticeable and requires regular shaving or removal of hairs in order to camouflage. May cause mild symptoms related to hair overgrowth | - | - |
| 2B. Marked increase in hair density thickness and/or length of hair that requires either frequent shaving or destruction of the hair to camouflage. May cause symptoms related to hair overgrowth. Without hair removal, inability to function normally in social, personal or professional situations | ||||
| Flushing | 1A. Face OR chest, asymptomatic, transient | 2A. Symptomatic on face, or chest, transient | 3A. Face and chest, transient, symptomatic | - |
| 1B. Any location, asymptomatic, permanent | 2B. Symptomatic on face, or chest permanent | 3B. Face and chest, permanent, symptomatic | ||
| Telangiectasia | One area (<1cm diameter) NOT affecting emotions or functioning | 2A. 2–5 (1cm diameter) areas NOT affecting emotions or functioning | More than 6 (1cm diameter) OR confluent areas affecting emotions or functioning | - |
| 2B. 2–5 (1cm diameter) areas affecting emotions or functioning | ||||
| Hyperpigmentati on | One area (<1cm diameter) NOT affecting emotions or functioning | 2A. 2–5 (1cm diameter) areas NOT affecting emotions or functioning | More than 6 (1cm diameter) OR confluent areas affecting emotions or functioning | - |
| 2B. 2–5 (1cm diameter) areas affecting emotions or functioning | ||||
| Mucositis -Oral -Anal | Mild erythema or edema, and asymptomatic | Symptomatic (mild pain, opioid not required); erythema or limited ulceration, can eat solid foods and take oral medication (oral mucositis only) | Pain requiring opioid analgesic; erythema and ulceration, cannot eat solids, can swallow liquids (Oral mucositis only) | Erythema and ulceration, cannot tolerate PO intake; require tube feeding or hospitalization (Oral mucositis only) |
| Radiation dermatitis | Faint erythema or dry desquamation | Moderate to brisk erythema; patchy moist desquamation, mostly confined to skin folds and creases; moderate edema | Moist desquamation other than skin folds and creases; bleeding induced by minor trauma or abrasion | Skin necrosis or ulceration of full thickness dermis; spontaneous bleeding from involved site |
| Hyposalivation | Can eat but requires liquids, no effect on speech | Moderate/thickened saliva; cannot eat dry foods, mild speech impairment (sticky tongue, lips, affecting speech) | No saliva, unable to speak without water, no oral intake without water | - |
| Taste | Altered or reduced taste; no impact on oral intake | Altered or reduced taste affecting interest and ability to eat; no intervention required | Taste abnormalities, requires intervention | - |
From Multinational Association of Supportive Cancer Care (2016). Supportive care in cancer. Available at: http://www.mascc.org