Skin cancer
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Skin Cancer. Nonmelanoma and Melanoma Skin Cancers. Objectives. The learner will be able to: Describe the major forms of skin cancer. Explain treatment modalities used to manage skin cancer. Identify prevention and detection strategies utilized in the management of skin cancer. Skin Cancer.

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Skin Cancer

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Skin cancer

Skin Cancer

Nonmelanoma and Melanoma Skin Cancers


Objectives

Objectives

The learner will be able to:

  • Describe the major forms of skin cancer.

  • Explain treatment modalities used to manage skin cancer.

  • Identify prevention and detection strategies utilized in the management of skin cancer.


Skin cancer1

Skin Cancer

  • Most common cancer in the United States

  • Approximately 1 out of every 5 Americans will be diagnosed with skin cancer during his or her lifetime.

  • 97% of skin cancers will be nonmelanoma skin cancers (NMSCs); basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the primary NMSCs.

  • An estimated 12,000 people will die from skin cancer in 2014.


Skin cancer2

Skin Cancer

  • Malignant melanoma is the most deadly form of skin cancer.

  • Incidence rates in whites are 5 times higher than in Hispanics and 20 times higher than in African Americans.

  • Has been one of the fastest increasing malignancies over the past few decades


Risk factors

Risk Factors

  • Sun exposure

  • Indoor tanning

  • Fair skinned; blond/red hair; blue/green eyes

  • Numerous or dysplastic nevi

  • Genetic predisposition

  • Immunosuppression


Basal cell carcinoma

Basal Cell Carcinoma

  • Comprises 70% of all skin cancers

  • Incidence increases with age.

  • Arises from keratinocytes

  • Slow-growing; locally invasive

  • Highly curable (almost 100% with early treatment)

  • Metastasis and death are rare.


Bcc signs and symptoms

BCC – Signs and Symptoms

  • Usually occurs on sun-exposed areas

  • Pale pink or red; translucent, pearly appearance

  • Scaling and ulceration may occur.

  • Can damage underlying tissue and skin if untreated


Squamous cell carcinoma

Squamous Cell Carcinoma

  • Like BCC, arises from keratinocytes

  • Accounts for 20% of all NMSCs

  • Mortality rate 1%2%

  • Frequently occurs on previously damaged skin

  • Metastasis possible


Scc signs and symptoms

SCC – Signs and Symptoms

  • Precancerous actinic keratosis lesions

  • Presentations vary:

    • Hard lesion with warty scale

    • Indurated, rounded base

    • Dull red lesion with teleangiectasis

    • Dome-shaped nodules with ulcerations and crusting


Diagnosis and staging

Diagnosis and Staging

  • Skin examination

  • Biopsy of suspicious lesions

  • Histologic examination

  • Staging is based on physical examination, pathology report, and lymph node involvement.


Treatment

Treatment

  • Surgery

    • Cryosurgery

    • Curettage and electrodesiccation

    • Excision

    • Mohs surgery


Treatment cont

Treatment (cont.)

  • Radiation therapy

    • Patients unable to tolerate surgery

    • Older patients with large lesions

  • Chemotherapy

    • Topical 5-FU


Malignant melanoma

Malignant Melanoma

  • Cancer of the melanocytes

  • Average age at diagnosis is 61; however, it is one of the most common cancers in younger adults, especially young women

  • Rates have been rising for at least 30 years

  • Expected 76,100 new cases in 2014 with expected 9710 deaths

  • Highly metastatic

  • Survival depends on early diagnosis and treatment.


Diagnosis and staging1

Diagnosis and Staging

  • Total excisional biopsy

  • Complete physical and skin check

  • Lab work and diagnostic tests to help determine the existence of metastatic disease

  • Breslow thickness

  • Lymph node involvement


Treatment of melanoma

Treatment of Melanoma

  • Surgical resection

  • Radiation therapy

  • Chemotherapy

  • Hyperthermic regional perfusion

  • Biotherapy


Skin cancer prevention

Skin Cancer Prevention

  • Reduce sun exposure.

  • Avoid indoor tanning, sun lamps.

  • Use sunscreens correctly and consistently.

  • Wear protective clothing.


Skin cancer detection

Skin Cancer Detection

  • Warning signs:

    • A sore that does not heal

    • Obvious change in a wart or mole

  • Screening/early detection

    • Self-examination

    • Physician/clinician examination


Abcde of self examination

ABCDE of Self-Examination

A = Asymmetry

B = Boarder

C = Color

D = Diameter

E = Evolving


References

References

American Cancer Society. (2014). Cancer facts and figures 2014. Retrieved from http://www.cancer.org/Research/CancerFactsFigures

Beam, S., Belansky, H.B., & Levy, C. (2009). Melanoma. In P. Muehlbauer & C. McGowan (Eds.), Skin cancer (pp. 5179). Pittsburgh, PA: Oncology Nursing Society.

Sheridan-Leos, N. (2007). Skin cancers. In M.E. Langhorne, J.S. Fulton, & S.E. Otto (Eds.), Oncology nursing (5th ed., pp. 298308). St. Louis, MO: Mosby.


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