Hospital ID: MRN: Radiation induced Surname: Other names: skin reaction DOB: Sex: assessment scale AMO: (RISRAS) MRN BAR CODE

Patient symptom scale – part A Symptoms Not at all A Quite Very For patients to complete little a bit much

We are interested in some things Do you have any tenderness,

about you and your skin which lie discomfort or pain of your skin in 1 2 3 4 within the radiotherapy treatment the treatment area? area. Does your skin in the treatment RISRAS

This information will help the area itch? 1 2 3 4 - team that is treating you. Do you have a burning sensation

Please answer all the questions of your skin in the treatment 1 2 3 4 cale s by circling the number that best area? applies to you. To what extent has your skin reaction and your symptoms affected your day to day 1 2 3 4 activities? ssessment a

Healthcare professional assessment scale – part B eaction

For treating team to complete r

Rate erythema by kin 0 1 2 3 4 s recording the degree Erythema (E) of colour change. Normal Dusky Dull red Brilliant Deep red/purple skin pink red

Rate ‘dry nduced i desquamation’, Dry 0 1 2 3 4 ‘moist desquamation’ desquamation and ‘necrosis’ by (DD) Normal <25% >25-50% >50-75% >75-100% evaluating the skin

proportion (%) of the Radiation Moist 0 1 2 3 4 treatment area desquamation affected by that (MD) Normal <25% >25-50% >50-75% >75-100% particular reaction. skin

Record grading (1-4) Necrosis (N) 0 1 2 3 4 on the ongoing assessment scale & Normal <25% >25-50% >50-75% >75-100% total the scores. skin

See the second page of this chart for further descriptors to assist in grading the signs.

Area of treatment:

RISRAS adapted from Noble-Adams, R. (1999)."Radiation induced skin reactions. Development of a measurement tool." BJN 8(18): 1208-11.

1 of 2 Descriptors to assist in grading the signs

Erythema Erythema is an indication of an Dry desquamation inflammatory reaction. The initial Dry desquamation may follow the response is reflected as a pale pink initial inflammation. The skin colour. The skin colour may then becomes very dry, scaly and flaky. increase in intensity to slightly red The cells may also become quite or mottled and it may then develop dark at times almost black, before from a brilliant red into a deep red they peel off. or purplish colour.

Acute necrosis Moist desquamation Complete destruction of the Moist desquamation is epidermis and ulcer formation is characterised by brilliant erythema, very rare. Necrosis is the formation of blisters, exudative demonstrated by black necrotic ulceration and/or loss of epithelial tissue or necrotic ulcer formation layers of the skin. Bleeding may with complete destruction of the also occur. epidermis.

Key: E, DD, MD, N as described above – ADL= Activities of daily living

Date # No. E DD MD N Pain Itch Burn ADLs Total Signature Radiationskin inducedreactionscale assessment RISRAS -

RISRAS adapted from Noble-Adams, R. (1999)."Radiation induced skin reactions. Development of a measurement tool." BJN 8(18): 1208-11.

© Cancer Institute NSW. Last reviewed January 2015. This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the contents at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. See www.eviq.org.au for our full disclaimer and any updates.

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