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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.
Therearethreemajortypesofskincancer:BasalCellCarcinoma,
SquamousCellCarcinoma,andMelanoma
BCCisanonmelanocyticskincancer(ie,anepithelialtumor)thatcomes
frombasalcells,whicharesmall,roundcellsfoundinthelowerlayerofthe
epidermis.
Themostcommonformofskincancer
About5.4millionbasalandsquamouscellskincancersarediagnosedeach
year.About8outof10ofthesearebasalcellcancers.
Theylooklikeopensores,redpatches,pinkgrowths
BCCalmostnevermetastasizesbeyondtheoriginaltumorsite,however,becauseitcan
stillinvadeanddestroysurroundingtissue,itistermedmalignant.
Commonlyfoundonpartsofthebodywithhighestsunexposure(ie:nose,shoulders)
Individualswhodevelopasinglelesionofbasalcellcarcinomaareatanincreasedriskof
developingadditionallesions.
Accordingtoestimates,theriskofdevelopingadditionallesionswithin3yearsis44%.
ANSWER: TRUE!
Peoplewhohaveskinofcoloroftenbelievetheyrenotatriskforskincancer,
butthatisadangerousmisconception.Whileincidenceofmelanomaishigherin
theCaucasianpopulation,aJuly2016studyintheJournaloftheAmerican
AcademyofDermatologyshoweditismoredeadlyinpeopleofcolor.African
Americanpatientsweremostlikelytobediagnosedwithmelanomainitslater
stagesthananyothergroupinthestudy,andtheyalsohadtheworstprognosis
andthelowestoverallsurvivalrate.
Secondmostcommonformofskincancer
Squamouscellsarefoundinthetissuethatformsthesurfaceoftheskin,theliningof
holloworgansofthebody,andthepassagesoftherespiratoryanddigestivetracts.
Squamouscellcarcinomasmayariseinanyofthesetissues
SCCusuallybeginsasadome-shapedbumporared,scalypatchofskin.
Itsusuallyroughandcrusty,andcanbleedeasilywhenscraped
ANSWER: FALSE
SquamousCellCarcinomaisadiseaseoftheOLDER
generation,usuallybetween68-70yearsorolder.(few
before40)
Foundinsun-exposedareasofthebody,aswellasscarsorchronicskinsores
SCCaremorelikelytogrowintodeeperlayersofskinandspreadtootherpartsofthe
bodythanbasalcellcancers
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
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
ANSWER: B
Thisispartofassessingthelesionandshouldbe
completed.TheABCDofskincancerdetectioninclude:
Asymmetry,Borders,Color,andDiameter.Thenurseshould
completeanassessmentonthelesionpriortonotifyingthe
HCPtocheckit.Lotionmayhelpasacomfortmeasure,but
itisnotthefirstaction.
Organtransplantpatientsareapproximately100timesmorelikelythanthegeneralpublic
todevelopBCCandSCC
Immunosuppressedpatients
Overexposureorlong-termexposuretox-rays,suchaspatientswhoreceivedx-ray
treatmentsforacneinthe1940s.
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.
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
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.
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.
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
Signaltransductioninhibitorsblocksignalsthatarepassedfromonemoleculetoanother
insideacell.
Blockingthesesignalsmaykillcancercells.
A.NotifytheHCPifasorethatdoesnothealdevelopsonthe
skin
B.Squamouscellcarcinomatumorsdonotmetastasize
C..Limitfoodstoliquidorsoftconsistencyfor1month
D.Applyheattotheareafor20minutesevery4hours.
ANSWER: A
Theclientshouldbeawareofsymptomsthatindicate
developmentofanotherskincancer.Squamouscellcarcinoma
candevelopinallareasoftheskinandmucousmembranes.
Seventy-fivepercentofdeathsfromsquamouscellcarcinomas
occurbecauseofmetastasis.Foodcanbeofaregular
consistency.Theclientshouldnotapplyheattothearea
BeawarethatcoveringupdoesntblockoutallUVrays.
Somesun-protectiveclotheshavealabellistingtheultravioletprotectionfactor(UPF)
value.
Putitonabout20to30minutesbeforeyougooutside.
Apalm-sizedamountofsunscreenshouldbeenoughtocoveranaverage
adultsarms,legs,neck,andface.
Reapplyatleastevery2hours
Donotusesunscreentostayoutinthesunlonger
Wear a Hat!
ANSWER: A
Clientshouldbeinstructedtoavoidexposuretothesunduring
thehottesttimeintheday.Thetimesvary,dependingonthe
areaofthecountry;forexample,intheSouthwestthetimes
periodislongerthanintheNorthwest.Sunscreenreducesthe
riskofskincancer.Thehigherthenumberofthesunscreen,the
moreUVraysareblocked.
TANNINGBEDS
GELMANICURES
VitaminDisneededtobuildbone.
VitaminDismadenaturallybyyourskinwhenyouareinthesun.
ItsbesttoprotectyourskinfromthesunandgetVitaminDbymouth(fromyourdietora
vitaminsupplement)
ExamplesofamountsofVitaminDinfoods:
3ozsalmon=447IU
1glass(8oz)ofvitaminDfortified
orangejuice=137IU
1glass(8oz)ofvitaminDfortified
milk=120IU