SKIN CANCER

Jody Gooding
Linsey Sekulich
Brandi Kusumoto
PRE Questions
1.What are the three MOST COMMON types of skin cancer? (select all
that apply)
a. Basal cell carcinoma

b. Merkel cell carcinoma

c. Squamous cell carcinoma

d. Melanoma

2.Which of the following is NOT included in the ABCDE method for self
assessing lesions?
a. Consistency

b. Diameter
 Disease As cells become more Extra cells divide
characterized by abnormal, old or without stopping
uncontrolled growth damaged cells survive and may form
of abnormal skin when they should have tumors
cells died

Exposure to ultraviolet People with light

radiation of the sun, complexions have a
irritating chemicals, higher rate of skin cancer
recurrent trauma, and than those with dark
irradiation complexions

Overexposure to sunlight is Males are more likely to

the major cause of skin develop skin cancer than
cancer females
https://infograph.venngage.com/p/107403/skin-cancer-cc
Actinic Keratosis (Premalignant)
Premalignant lesions of the cells of the epidermis

Progression to squamous cell carcinoma if not treated

Clinical Manifestations:
Small (1-10 mm) macule or papule with dry, rough, adherent yellow or brown scales

Base may be erythematous

Associated with yellow, wrinkled, weather-beaten skin

Thick indurated keratoses more likely to be malignant

Distribution:
Cheeks, temples, forehead, ears, neck, back of hands, forearms
Squamous Cell Carcinoma
Cancer of the epidermis

Can invade locally and potentially

metastasize

Second most common skin cancer

Clinical Manifestations:
Firm, nodular lesion topped with a crust or a central
area of ulceration

Indurated margins

Fixation to underlying tissue with deep invasion

Distribution:
 Arise from the basal cell layer of the
epidermis
Basal Cell Carcinoma
Most common skin cancer

Ultraviolet rays from the sun or

tanning beds is the main cause

Clinical Manifestations:
Pearly papule with a central crater and
rolled, waxy borders

Telangiectasias (widened venules that cause

threadlike red lines) and pigment flecks
visible on close inspection

Distribution:
Sun exposed areas, especially the head,
neck and central portion of the face
Melanoma
Pigmented cancer arising in melanin producing epidermal cells

Unpredictable, rare but highly malignant

Most often start as benign growth of a nevus (mole)

Normal nevi have regular, well-defined borders and are uniform in color, ranging from
light colors to dark brown

Lesion surface may be rough or smooth

Nevi with irregular or spreading borders and those with multiple colors are abnormal

Other abnormal findings are sudden changes in lesion size, itching and bleeding

The prognosis is based on size, depth of invasion of the tumor, and the
presence of metastasis
Melanoma Cont.
Clinical Manifestations:
Irregularly shaped, pigmented papule or plaque

Variegated colors, with red, white and blue tones

Distribution:
Can occur anywhere on the body, especially where
nevi (moles) or birthmarks are evident

Commonly found on upper back, lower legs, soles of

feet and palms in dark-skinned people

Course
Horizontal growth phase followed by vertical growth
Preventative Teaching
MOST effective strategy is to avoid the
sun!

Secondary prevention (early detection)

crucial to survival with melanoma.

Body awareness/Body markings map

Monthly self-checks

If you find lesions, use ABCDE guide

for melanoma.

Asymmetry, Border irregularity, Color,

Diameter (greater than 6mm),
Skin Self-Assessment
1.Examine face: focus on nose, lips, mouth, and ears.

2.Scalp: use mirrors and a blow-dryer to view as many

sections as possible.

3.Hands: palms & backs, between fingers and under nails.

Continue up forearms

4.Upper arms: all sides, including axillae

5.Neck, chest, torso: women lift breasts to view underside

6.Back of the neck, shoulder, upper back: use full length

mirror and hand mirror

7.Lower back, buttocks, back of the legs

Seek Medical Advice if you note any of these:
A change in color of a lesion, especially if it darkens or shows
evidence of spreading
A change in the size of a lesion, especially rapid growth
A change in the shape of a lesion, such as a sharp border becoming
irregular or a flat lesion becoming raised
Redness or swelling of the skin around a lesion
A change in sensation, especially itching or increased tenderness of a
lesion
A change in the character of a lesion, such as oozing, crusting,
bleeding, or scaling
Interventions

Surgical and Nonsurgical interventions are combined for effective

treatment in skin cancer.

Treatment is determined by the size and severity of the malignancy,

the location of the lesion, and the age and general health of the
patient.
Surgical Management

Cryosurgery - cell destruction by the local application of liquid nitrogen (200 C) to

isolated lesions, causing cell death and tissue destruction.

Curettage and electrodesiccation - removal of cancerous cells with the use of a

dermal curette to scrape away cancerous tissue, followed by the application of an electric
probe to destroy remaining tumor tissue.

Excisional biopsy - total surgical removal of small lesions for pathologic examination.

Mohs' surgery - a specialized form of excision usually for basal and squamous cell
carcinomas. Tissue is sectioned horizontally in layers, and each layer is examined
histologically to determine the presence of residual tumor cells.

Wide excision - deep skin resection often involving removal of full-thickness skin in the
area of the lesion. Depending on tumor depth, subcutaneous tissues and lymph nodes
may also be removed.
 Topical Therapy - Used to treat
Nonsurgical Management
multiple actinic keratosis or for
widespread superficial basal cell
carcinoma. Therapy is continued for
several weeks, and treated areas
become increasingly tender and
inflamed as lesions crust, ooze, and
erode. Prepare patient for an
unsightly appearance during
therapy, and reassure them that
cosmetic result will be positive.

Systemic Chemotherapy -
Systemic chemotherapeutic agents
are used in treatment of locally
advanced or metastatic squamous
cell skin cancer.
Nonsurgical Management Cont.
Biotherapy - Biotherapy with interferon, monoclonal
antibodies, and targeted therapy are now accepted
treatment for melanoma after surgical removal.
Interferon is used for melanomas that are at stage III or
higher. Monoclonal antibody therapy leads to greater T-
cell lymphocyte activity. Targeted therapy is available
for melanomas with specific mutation in the BRAF gene.

Radiation Therapy - When used for skin cancer is limited to older

patients with large, deeply invasive basal cell tumors and to those who
are poor risks for surgery. Melanoma is relatively resistant to radiation
therapy.
Nonsurgical Management - Drug
Examples
5-fluorouracil Topical
cream chemotherapy

Cisplatin or Systemic
Carboplantin chemotherapy

5-fluorouracil Systemic
chemotherapy

Cetuximab Systemic
(Erbitux) chemotherapy

Vismodegib Systemic
(Erivedge) chemotherapy

interferon Biotherapy

Ipilimumab Monoclonal
POST Questions
1.What are the three MOST COMMON types of skin cancer? (select all
that apply)
a. Basal cell carcinoma

b. Merkel cell carcinoma

c. Squamous cell carcinoma

d. Melanoma

2. Which of the following is NOT included in the ABCDE method for self
assessing lesions?

a. Consistency
References
Copstead, L. C., & Banasik, J. L. (2013). Pathophysiology (5th ed.). St.
Louis, MO: Elsevier.

Ignatavicius, D. D., & Workman, M. L. (2016). Medical-surgical nursing:

patient-centered collaborative care (8th ed.). St. Louis, MO: Elsevier.

National Cancer institute (https://www.cancer.gov/)