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WHAT IS SKIN CANCER?

Skin cancersarecancersthatarisefromtheskin.Theyareduetothedevelopmentof
abnormalcellsthathavetheabilitytoinvadeorspreadtootherpartsofthebody.

ItoccurswhenunrepairedDNAdamagetoskincellstriggersmutations,orgenetic
defects,thatleadtheskincellstomultiplyrapidlyandformmalignanttumor.

THE FACTS

EachyearintheU.S.over5.4millioncasesofnon-melanomaskincanceraretreatedin
morethan3.3millionpeople.

Eachyeartherearemorenewcasesofskincancerthanthecombinedincidenceof
cancersofthebreast,prostate,lungandcolon.

Overthepastthreedecades,morepeoplehavehadskincancerthanallothercancers
combined.

OneinfiveAmericanswilldevelopskincancerinthecourseofalifetime.

Between40and50percentofAmericanswholivetoage65willhaveeitherbasalcell
carcinomaorsquamouscellcarcinomaatleastonce.

TheannualcostoftreatingskincancersintheU.S.isestimatedat$8.1billion:about
$4.8billionfornon-melanomaskincancersand$3.3billionformelanoma.

Theannualincidencerateofmelanomais1per100,000in
blacks,4per100,000inHispanics,and25per100,000innonHispanicwhites.

Different Types of Skin Cancer

Therearethreemajortypesofskincancer:BasalCellCarcinoma,
SquamousCellCarcinoma,andMelanoma

Under the Surface

BASAL CELL CARCINOMA

BCCisanonmelanocyticskincancer(ie,anepithelialtumor)thatcomes
frombasalcells,whicharesmall,roundcellsfoundinthelowerlayerofthe
epidermis.
Themostcommonformofskincancer
About5.4millionbasalandsquamouscellskincancersarediagnosedeach
year.About8outof10ofthesearebasalcellcancers.
Theylooklikeopensores,redpatches,pinkgrowths

BASAL CELL CARCINOMA

BCCalmostnevermetastasizesbeyondtheoriginaltumorsite,however,becauseitcan
stillinvadeanddestroysurroundingtissue,itistermedmalignant.

Commonlyfoundonpartsofthebodywithhighestsunexposure(ie:nose,shoulders)

Individualswhodevelopasinglelesionofbasalcellcarcinomaareatanincreasedriskof
developingadditionallesions.

Accordingtoestimates,theriskofdevelopingadditionallesionswithin3yearsis44%.

True or False: Basal Cell Carcinomas


rarely develop in darker skinned
people. But if does happen to develop
it is normally found on the hands &
feet.

ANSWER: TRUE!
Peoplewhohaveskinofcoloroftenbelievetheyrenotatriskforskincancer,
butthatisadangerousmisconception.Whileincidenceofmelanomaishigherin
theCaucasianpopulation,aJuly2016studyintheJournaloftheAmerican
AcademyofDermatologyshoweditismoredeadlyinpeopleofcolor.African
Americanpatientsweremostlikelytobediagnosedwithmelanomainitslater
stagesthananyothergroupinthestudy,andtheyalsohadtheworstprognosis
andthelowestoverallsurvivalrate.

SQUAMOUS CELL CARCINOMA

Secondmostcommonformofskincancer

Squamouscellsarefoundinthetissuethatformsthesurfaceoftheskin,theliningof
holloworgansofthebody,andthepassagesoftherespiratoryanddigestivetracts.

Squamouscellcarcinomasmayariseinanyofthesetissues

SCCusuallybeginsasadome-shapedbumporared,scalypatchofskin.

Itsusuallyroughandcrusty,andcanbleedeasilywhenscraped

True or False: Squamous Cell


Carcinoma is a disease of the younger
generation, usually between the ages
of 20-40.

ANSWER: FALSE
SquamousCellCarcinomaisadiseaseoftheOLDER
generation,usuallybetween68-70yearsorolder.(few
before40)

SQUAMOUS CELL CARCINOMA

Foundinsun-exposedareasofthebody,aswellasscarsorchronicskinsores

SCCaremorelikelytogrowintodeeperlayersofskinandspreadtootherpartsofthe
bodythanbasalcellcancers

Difference Between SCC and BCC

BCCappearslikeapearlyorwaxylookingbump.Itmayalsolooksimilartoascar,
appearingasaflesh-coloredorbrownflatunusualarea

SCCbeginsasafirmred-colorednodule.Itcanalsoremainflat,butthesurfacelooks
scalyandcrusty.

MELANOMA

Onepersondiesofmelanomaeveryhour(every52minutes)

Anestimated10,130peoplewilldieofmelanomain2016.

Onaverage,apersonsriskformelanomadoublesifheorshehashadmorethanfive
sunburns.

MELANOMA

Producesinthemelanocytesthatproducemelanin(givesskinitscolor)

Canbefoundalloverthebody,aswellastheeyes,andevenintheintestines

Oftenachangeinanexistingmoleordevelopmentofnewmole

Candevelopinareasofthebodythathavelittletonoexposuretosun,suchasthespace
betweenyourtoes,palms,nailbeds

Canbegenetic-ifaparent,child,orsiblinghashadmelanoma,yourchancesofgetting
melanomaincreases

Different Types of Melanoma

When assessing a lesion diagnosed as nodular


melanoma, the nurse most likely expects to note
which of the following?
A.Afuruncle
B.Asmallpapulewithadry,rough,scale
C.Asmooth,round,blue-blacklesion.
D.Apearlypapulewithacentralcraterandawaxy
border

ANSWER: C
ThinkNodularMelanomaBlueberrySmooth,spherical,andblue-blackin
color.

EARLY DETECTION

Payattentiontoyourbody(selfexam)newskinlesions/bumps;payattentiontothe
size and shape ofanymoles,andwhethertheyaregrowingornot.

Dermatologistvisitatleastonce a year

Dermatologistcanexciseandbiopsytoconfirmordenythepresenceofcancer.

BloodLDH(lactasedehydrogenase)levelsareusuallyhigherifmetastaticdiseaseis
present.

CXR,andcertainlabtestssuchasCBC,LDH,andCreatininecanhelpindetecting
metastasisafterdiagnosisofmelanomaisconfirmed.

Risk Factors
MODIFIABLE

NON-MODIFIABLE

LESSEXPOSURETOUVRAYS/SUN

LIGHTSKIN,LIGHTEYES,CELTIC
ORIGIN

EXPOSURETOCHEMICAL
POLLUTANTS(EX:ARSENIC,COAL,
TAR,ETC.)

AGE:ADULTSOVER50AREAT
HIGHERRISK
MALE:MENARE2XMORELIKELYTO
DEVELOPBCC
FAMILYHISTORY/GENETICS
IMMUNOSUPPRESSION
PEOPLEWITHCHRONICSKIN
CONDITIONS
PEOPLEWHOGETSUNBURNED

The nurse notes an irregular-shaped lesion with some


scabbed areas surrounding the lesion on the clients
back. Which action should the nurse implement first?
A.PlaceanoteontheclientschartfortheHCPtocheckthe
lesiononrounds.
B.Measurethelesion,notethecolor,anddocumentthefinding
inthechart.
C.Applylotiontothelesion,andremindtheclientnottoscratch
thearea.
D.InstructtheclienttomakesuretheHCPchecksthelesion

ANSWER: B
Thisispartofassessingthelesionandshouldbe
completed.TheABCDofskincancerdetectioninclude:
Asymmetry,Borders,Color,andDiameter.Thenurseshould
completeanassessmentonthelesionpriortonotifyingthe
HCPtocheckit.Lotionmayhelpasacomfortmeasure,but
itisnotthefirstaction.

Additional Ways to Get BCC & SCC

Organtransplantpatientsareapproximately100timesmorelikelythanthegeneralpublic
todevelopBCCandSCC

Immunosuppressedpatients

Overexposureorlong-termexposuretox-rays,suchaspatientswhoreceivedx-ray
treatmentsforacneinthe1940s.

The male client diagnosed with acquired immune deficiency


syndrome (AIDS) states that he has developed a purple-brown
spot on his calf. Which intervention should the nurse
implement first?

A.RefertheclienttoanHCPforabiopsyofthearea
B.Assessthelesionforsize,color,andsymmetry.
C.Asktheclienttoremovetheclothingfromthecalf
D.Reportthesexuallytransmitteddisease(STD)tothe
healthdepartment.

ANSWER: C
Thenursemustbeabletoseetheareathatistobe
assessed.Assessingthelesionisthesecondstepin
decidinghowtoassisttheclient.Thenurseshould
assessthelesiontodetermineifthelesioncouldbea
sarcomaorahealingcontusion.Theclientmay
requireabiopsy,butthatisnotthefirstintervention.
ReportinganSTDisnotpriority.

Which of the following patients is at the highest risk


of developing skin cancer?
A.A70yearoldwomanwhogardensfortwohourseachday
betweenthehoursof6amand8am.
B.A25yearoldcoalminerwhotansweeklyinatanningbed
andwhowasrecentlydiagnosedwithHIV.
C.Apatientswithlungcancer.
D.ApatientwhotakesadailyvitaminDsupplement

ANSWER: B
Thisindividualisatthehighestriskfordevelopingskincancer.
Thecoalminerisexposedtocoalwhichhasbeenassociated
withskincancer.Healsotansregularlysoisregularlyexposed
toconcentratedUVlight,andhasHIV.HIVpatientsareat
increasedriskofdevelopingskincancerastheirimmune
systemsaresuppressed.

DIAGNOSING

Skinbiopsy:Allorpartoftheabnormal-lookinggrowthiscutfromtheskinand
viewedunderamicroscopebyapathologisttocheckforsignsofcancer.Thereare
fourmaintypesofskinbiopsies:

Shavebiopsy:Asterilerazorbladeisusedtoshave-offtheabnormal-looking
growth.

Punchbiopsy:Aspecialinstrumentcalledapunchoratrephineisusedtoremovea
circleoftissuefromtheabnormal-lookinggrowth.

Incisionalbiopsy:Ascalpelisusedtoremovepartofagrowth.

Excisionalbiopsy:Ascalpelisusedtoremovetheentiregrowth.

TREATMENT

Sixtypesofstandardtreatmentareused:
Surgery
Radiationtherapy
Chemotherapy
Photodynamictherapy
Biologictherapy
Targetedtherapy

A male client schedule for a skin biopsy is


concerned and asks the nurse how painful the
procedure is. The appropriate response by the
nurse is:
A. There is no pain associated with this procedure
B. The local anesthetic may cause a burning or stinging
sensation
C. A preoperative medication will be given so you will be
sleeping and will not feel any pain
D. There is some pain, but the physician will prescribe
an opioid analgesic following the procedure

ANSWER: B
Dependingonthesizeandlocationofthelesion,abiopsyis
usuallyaquickandalmostpainlessprocedure.Themost
commonsourceofpainistheinitiallocalanesthetic,which
canproduceaburningorstingingsensation.Preoperative
medicationisnotnecessarywiththisprocedure.

SURGERY

Micrographicsurgery:Thetumoriscutfromtheskininthinlayers.Duringsurgery,the
edgesofthetumorandeachlayeroftumorremovedareviewedthroughamicroscopeto
checkforcancercells.Layerscontinuetoberemoveduntilnomorecancercellsare
seen.Thistypeofsurgeryremovesaslittlenormaltissueaspossibleandisoftenusedto
removeskincancerontheface.

Simple excision:Thetumoriscutfromtheskinalongwithsomeofthenormalskin
aroundit.

Electrodesiccation curettage:Thetumoriscutfromtheskinwithacurette(asharp,
spoon-shapedtool).Aneedle-shapedelectrodeisthenusedtotreattheareawithan
electriccurrentthatstopsthebleedinganddestroyscancercellsthatremainaroundthe
edgeofthewound.Theprocessmayberepeatedonetothreetimesduringthesurgery
toremoveallofthecancer.

The middle-aged client has had a basal cell carcinoma


removed. Which statement indicates the client understands
the discharge teaching?
A.IamsogladthatIdonthavetoworryaboutskincancer
anymore.
B.Ineedtoseeaprostheticspecialisttocamouflagethe
damagedarea.
C.Iwillapplyasunscreentotheincisiontomakesurenomore
cancerisfound.
D.Iwillcheckmyskineverymonthforanymoresuspicious
lesions

ANSWER: D
Theclientshouldcheckforanylesionthatcouldbe
cancerousmonthly.Theclienthashadoneskin
cancerremoved,butnotjustthatareaofskinhas
beendamagedbyUVrays.Prosthesesareusually
notneeded.Sunscreenisnotappliedtoincisionsand
doesnotguaranteethatmorecancercellswillnotbe
found.

OTHER METHODS

Cryosurgery:Atreatmentthatusesaninstrumenttofreezeanddestroyabnormaltissue,
suchascarcinoma.Thistypeoftreatmentisalsocalledcryotherapy.

Laser therapy:Asurgicalprocedurethatusesalaserbeam(anarrowbeamofintense
light)asaknifetomakebloodlesscutsintissueortoremoveasurfacelesionsuchasa
tumor.

Dermabrasion:Removalofthetoplayerofskinusingarotatingwheelorsmallparticles
torubawayskincells.

The nurse prepares discharge instructions for a


male client following cryosurgery for the treatment
of a malignant skin lesion. Which of the following
should the nurse include in the instruction?
A.Avoidshoweringfor7to10days
B.Applyicetothesitetopreventdiscomfort
C.Applyalcohol-soakeddressingtwiceaday
D.Cleanthesitewithhydrogenperoxidetopreventinfection

ANSWER: D
Cryosurgeryinvolvesthelocalapplicationofliquidnitrogento
isolatedlesionsandcausescelldeathandtissuedestruction.The
nurseinformstheclientthatswellingandincreasedtendernessof
thetreatedareacanoccurwhentheskinthaws.Tissuefreezingis
followedbyhemorrhagicblisterformationin1to2days.Thenurse
instructstheclienttocleanthetreatmentsitewithhydrogenperoxide
topreventsecondaryinfection.Atopicalantibioticalsomaybe
prescribed.Applicationofawarm,dampwashclothintermittentlyto
thesitewillproviderelieffromanydiscomfort.Alcohol-soaked
dressingswillcauseirritation.Theclientdoesnotneedtoavoid
showering.

RADIATION THERAPY

Radiation therapyisacancertreatmentthatuseshigh-energyX-raysorothertypesof
radiationtokillcancercellsorkeepthemfromgrowing.

Therearetwotypesofradiationtherapy:

Externalradiationtherapyusesamachineoutsidethebodytosendradiation
towardthecancer.
Internalradiationtherapyusesaradioactivesubstancesealedin
needles,seeds,wires,orcathetersthatareplaceddirectlyintoornearthe
cancer.

CHEMOTHERAPY

Systemicchemotherapytakenbymouthorinjectedintoaveinormuscle,the
drugsenterthebloodstreamandcanreachcancercellsthroughoutthebody.

Regionalchemotherapy-isplaceddirectlyintothecerebrospinalfluid,anorgan,
orabodycavity.

Fornon-melanomaandactinickeratosisusuallytopical.Thedrugsmainly
affectcancercellsinthoseareas.

PHOTODYNAMIC THERAPY

Usesadrugandacertaintypeoflaserlighttokillcancercells.Adrugthatisnotactive
untilitisexposedtolightisinjectedintoavein.Thedrugcollectsmoreincancercells
thaninnormalcells.

Forskincancer,laserlightisshinedontotheskinandthedrugbecomesactiveandkills
thecancercells.

Photodynamictherapycauseslittledamagetohealthytissue.

BIOLOGIC THERAPY
Biologic therapy(biotherapy or immunotherapy) isatreatment
thatusesthepatientsimmunesystemtofightcancer.Substances
madebythebodyormadeinalaboratoryareusedtoboost,direct,or
restorethebodysnaturaldefensesagainstcancer.
Skin cancer-Interferonandimiquimod:
Interferon (by injection)-maybeusedtotreatsquamous cell
carcinomaoftheskin.
Imiquimod (topical therapy) - acreamappliedtotheskinmaybe
usedtotreatsomesmall basal cell carcinomas.

TARGETED THERAPY

Targetedtherapywithasignaltransductioninhibitorisusedtotreat basal cell


carcinoma.

Signaltransductioninhibitorsblocksignalsthatarepassedfromonemoleculetoanother
insideacell.

Blockingthesesignalsmaykillcancercells.

The client has had a squamous cell carcinoma removed from


the lip. Which discharge instructions should the nurse
provide?

A.NotifytheHCPifasorethatdoesnothealdevelopsonthe
skin
B.Squamouscellcarcinomatumorsdonotmetastasize
C..Limitfoodstoliquidorsoftconsistencyfor1month
D.Applyheattotheareafor20minutesevery4hours.

ANSWER: A
Theclientshouldbeawareofsymptomsthatindicate
developmentofanotherskincancer.Squamouscellcarcinoma
candevelopinallareasoftheskinandmucousmembranes.
Seventy-fivepercentofdeathsfromsquamouscellcarcinomas
occurbecauseofmetastasis.Foodcanbeofaregular
consistency.Theclientshouldnotapplyheattothearea

So What Can You do to Prevent Skin Cancer?


Theresnosurewaytopreventskincancer.
Buttherearethingseveryonecandotohelpreducetheirriskofboth
melanomaandnon-melanomaskincancers.

Protect Your Skin with Clothing

BeawarethatcoveringupdoesntblockoutallUVrays.

Somesun-protectiveclotheshavealabellistingtheultravioletprotectionfactor(UPF)
value.

Use a Broad-Spectrum Sunscreen Thats at


Least SPF 30

Putitonabout20to30minutesbeforeyougooutside.
Apalm-sizedamountofsunscreenshouldbeenoughtocoveranaverage
adultsarms,legs,neck,andface.

Reapplyatleastevery2hours
Donotusesunscreentostayoutinthesunlonger

Wear a Hat!

Stay in the Shade


Especiallyduringthehottestpartoftheday(often10a.m.to
4p.m.)
Shadowtest:Ifyourshadowisshorterthanyou,thesuns
raysarethestrongeststayinsideorbeextracareful.

The nurse participating in a health fair is discussing


malignant melanoma with a group of clients. Which
information regarding the prevention of skin cancer
should the nurse include?
A.Avoidbeinginthesunduringthehottesttimeofday
B.Sunscreenincreasestheriskofskincancerintoddlers
C.Sunscreendoesnothelppreventskincancer
D.Thelowerthenumberofthesunscreen,themoreitblocksUV
rays.

ANSWER: A
Clientshouldbeinstructedtoavoidexposuretothesunduring
thehottesttimeintheday.Thetimesvary,dependingonthe
areaofthecountry;forexample,intheSouthwestthetimes
periodislongerthanintheNorthwest.Sunscreenreducesthe
riskofskincancer.Thehigherthenumberofthesunscreen,the
moreUVraysareblocked.

EFFECTS OF SUN DAMAGE

Avoid Other Sources of UV Light

TANNINGBEDS

GELMANICURES

A Word About Vitamin D

VitaminDisneededtobuildbone.

VitaminDismadenaturallybyyourskinwhenyouareinthesun.

ItsbesttoprotectyourskinfromthesunandgetVitaminDbymouth(fromyourdietora
vitaminsupplement)

ExamplesofamountsofVitaminDinfoods:
3ozsalmon=447IU
1glass(8oz)ofvitaminDfortified
orangejuice=137IU
1glass(8oz)ofvitaminDfortified
milk=120IU

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