BAGUIO CENTRAL UNIVERSITY
STO. NIÑO JESUS MEDICAL CENTER
NO. 28 LOWER P. BURGOS, BAGUIO CITY 2600
SKIN CANCER
In partial fulfillment of requirements in
Nursing Care Management 106
This Oncology Nursing Study is Presented by:
Eduardo M. Lofstedt Jr., SN
AT THE END OF THE LESSON YOU SHOULD BE ABLE TO:
Recall the Structure and Function of the Skin
Learn and understand the what a skin cancer, the different types, it’s
causes, clinical manifestation, risk factors for Skin Cancer, prevention, and
treatment.
Learn and understand the ABCD rule for the early detection of melanoma
Learn and understand the nursing intervention for Skin Cancer.
OVERVIEW
I. Anatomy & Physiology of the Skin
II. Skin Cancer: Description; Etiology; Clinical Manifestation; Treatment
III. KNOWLEDGE CHECK
I. The Anatomy & Physiology of the
Skin
The Anatomy & Physiology of Skin: Integumentary System
The Integumentary System
The integumentary system consist of the skin hair, oil and sweat
glands, nails, and sensory receptors.
Normal thickness is 1-2 mm, up to 6 mm – thicker skin (palms and
soles) has stratum lucidum, no hair follicles or sebaceous glands.
The Integumentary System
The skin is the largest organ of
the body in weight (15% of
body weight). The principal
parts of the skin are the
epidermis (superficial) and
dermis (deep).
Epidermis (superficial) – stratified
squamous epithelium. This
contains 5 layers.
Dermis (deep) – connective tissue
layer.
The Integumentary System
The subcutaneous layer
(hypodermis) is deep to the
dermis and NOT part of the
skin. It anchors the dermis
to underlying tissues and
organs, and it contains
lamellated corpuscles.
The Integumentary System
The types of cells in the
epidermis are
keratinocytes, melanocytes,
intraepidermal
macrophages, and tactile
epithelial cells.
The Integumentary System
The epidermal layers, from
deep to superficial, are the
stratum basale, straum
spinosum, stratum corneum.
The stem cells in the stratum
basale undergo continuous cell
division, producing
keratinocytes for the other
layers.
The Integumentary System (cont.)
The dermis is composed of dense irregular
connective tissue containing collagen and elastic
fibers. It is divided into papillary and reticular
regions. The papillary region contains thin
collagen and fine elastic fibers, dermal papillae,
and corpuscles of touch. The reticular region
contains bundles of thick collagen and some
coarse elastic fibers, fibroblasts and
macrophages, adipose tissue, hair follicles,
nerves, sebaceous (oil) glands, and sudoriferous
(sweat) glands.
The Integumentary System (cont.)
Epidermal ridges provide
the basis for fingerprints
and footprints.
The Integumentary System (cont.)
The color of skin is due to
melanin, carotene, and
hemoglobin.
TRIVIA!!!
Friction ridge skin has unique features that persist
from before birth until decomposition after death.
Upon contact with a surface, the unique features of
friction ridge skin may leave an impression of
corresponding unique details. Two impressions can
be analyzed, compared, and evaluated, and if
sufficient quality and quantity of detail is present
(or lacking) in a corresponding area of both
impressions, a competent examiner can effect an
individualization or exclusion (identify or exclude an
individual). The analysis, comparison, evaluation,
and verification (ACE-V) methodology, combined
with the philosophy of quantitative–qualitative
examinations, provide the framework for practical
application of the friction ridge examination
discipline.
Who will forget the CSI: Crime Scene Investigation???
CSI: Crime Scene Investigation, also
referred to as CSI and CSI: Las Vegas, is an
American procedural forensics crime
drama television series which ran on CBS
from October 6, 2000, to September 27,
2015, spanning 15 seasons. The series
starred William Petersen, Marg
Helgenberger, George Eads, Ted Danson,
Laurence Fishburne, Elisabeth Shue, and
Jorja Fox and was the first in the CSI
franchise. The series concluded with a
feature-length finale titled "Immortality".
II. Skin Cancer: Description; Etiology;
Clinical Manifestation; Treatment
SKIN CANCERS
SKIN CANCERS
Description:
occurs when cells in the epidermis turn into cancerous cells.
Etiology:
They are due to the development of abnormal cells that have the ability
to invade or spread to other parts of the body.
*The type of skin cancer depends on the cell type affected in the
epidermis.
Incidence:
Currently, between 2 and 3 million non-melanoma skin cancers and
132,000 melanoma skin cancers occur globally each year. One in every
three cancers diagnosed is a skin cancer and, according to Skin Cancer
Foundation Statistics, one in every five Americans will develop skin
cancer in their lifetime.
2 MAIN DIFFERENT TYPES OF SKIN CANCER & THEIR
CLINICAL MANIFESTATIONS
1. Nonmelanoma
2. Melanoma
1. NONMELANOMA SKIN CANCER
refers to all the types of cancer that occur in the
skin that are not melanoma.
1. NONMELANOMA SKIN CANCER
a. Basal Cell Skin Carcinoma
b. Squamous Cell Skin Carcinoma
c. Actinic Keratosis (solar keratosis)
d. Merkel Cell Carcinoma
a. Basal Cell Skin
Carcinoma -
originates from the
basal cell in the
stratum basale.
b. squamous cell skin
cancer - originates from the
keratinocytes in the stratum
spinosum.
c. Actinic keratosis (solar
keratosis)- is a precancerous type
of skin cancer that can turn into
squamous cell carcinoma, if not
removed.
- It tends to affect older white
adults and forms in areas exposed
to the sun like the top of the head,
face, arms etc.
d. Merkel Cell Carcinoma - is a
rare and aggressive cancer. Forming
in the Merkel cells deep within the
top layer of the skin, this type of
cancer often appears as a shiny
pink, red or bluish lump that grows
quickly. It also usually appears as a
flesh-colored or bluish-red nodule,
often on your face, head or neck.
2. MELANOMA SKIN CANCER
occurs when melanocytes mutate into cancerous
cell. Melanocytes release a substance called melanin
that gives the hair, skin, and eyes their color. The
melanocytes are found in the stratum basale.
Melanoma Skin Cancer
2. MELANOMA SKIN CANCER (CONT.)
It is the most aggressive and very serious type of skin cancer, but early
detection saves many lives.
- is a relatively common cancer that begins in the melanocytes, which
are the pigment-producing cells located on the top layer of the skin.
- Damage caused by ultraviolet (UV) light from the sun and tanning beds
can trigger cancerous changes in these cells, but melanoma may also
develop in areas of the body that aren’t exposed to the sun.
2. MELANOMA SKIN CANCER
occurs when melanocytes mutate into cancerous
cell. Melanocytes release a substance called melanin
that gives the hair, skin, and eyes their color. The
melanocytes are found in the stratum basale.
RISK FACTORS FOR SKIN CANCER
Too much sun exposure (using tanning beds)
Predisposition due to genetics (melanoma can be
more common in certain families)
Light skin, blonde, red hair, green or blue eyes
Exposure to toxic chemicals
History of frequent sunburns as a child
NURSING INTERVENTIONS FOR SKIN CANCER
Too much sun exposure (using tanning beds)
Predisposition due to genetics (melanoma can be
more common in certain families)
Light skin, blonde, red hair, green or blue eyes
Exposure to toxic chemicals
History of frequent sunburns as a child
The ABCDE Rule of Skin Cancer
- is an easy-to-remember system for determining whether a mole or
growth may be cancerous. They describe the physical condition and/or
progression of any skin abnormality that would suggest the development
of a malignancy.
Asymmetrical
Borders uneven
Color dark (black)
Diameter greater than 6mm
Evolution present
Asymmetrical
- if you draw a line in the middle of it, it should look
the same on each side…abnormal would be that it
doesn’t look the same (asymmetrical)
Borders
- The outer edges are uneven.
Color
- have dark black or have multiple colors.
- Watch out for dark black or multiple colors.
Diameter
- greater than 6mm
Evolving
- changes in size, shape, and color
ASSESSMENT
Asymmetrical: if you draw a line in the middle of it, it
should look the same on each side…abnormal would be
that it doesn’t look the same (asymmetrical)
Border are uneven
Color: watch out for dark black or multiple colors
Diameter: greater than 6mm
Evolution: changes in size, shape, and color
PLANNING : PREVENTIVE
Avoid direct sun exposure between 10 am – 4 pm (sun rays
are the strongest during these times)
Wear long-sleeves, sun glasses, and a hat to avoid
unnecessary sun exposure.
Use a sunscreen that is broad-spectrum with a SPF of 15 or
higher for exposed areas when outside.
Avoid tanning beds and toxic chemical on the skin.
IMPLEMENTATION
Treatment depends on the type of cancer and stage.
However, the cancerous tissue will be removed.
IMPLEMENTATION (CONT.)
Cryosurgery (freezes off
the cancerous tissue
with liquid nitrogen)
IMPLEMENTATION (CONT.)
radiation (used for
difficult to treat areas
and will kill the
cancerous cells)
IMPLEMENTATION (CONT.)
chemotherapy (kill
cancerous cells)…
topical: if hasn’t spread
or systematic chemo if it
has spread
IMPLEMENTATION (CONT.)
Electrodessication and Curettage
(EDC): scraps and removes the
abnormal tissue and an electrical
current is used to prevent
bleeding and to kill the cancerous
cells…this is repeated a few
times…Nursing care for surgical
site: cover with petroleum jelly
and nonstick bandage.
III. KNOWLEDGE CHECK
1. True or False: Basal and squamous cell carcinoma
are both considered nonmelanoma types of skin
cancer.*
True
False
Answer: TRUE
2. The epidermis consists of ________ layers with the
innermost layer of the epidermis being known as the
__________.*
A. five, stratum lucidum
B. three, stratum spinosum
C. five, stratum basale
D. three, stratrum granulosum
The answer is C. The epidermis consists of FIVE layers
with the innermost layer of the epidermis being known
as the stratum basale.
3. Which statement is true regarding the pathophysiology of
melanoma?*
A. "Melanoma develops when keratinocytes mutate in the
stratum germinativum."
B. "Melanoma of the skin originates from melanocytes found
in the stratum basale."
C. "Melanoma only occurs on the skin and is the most
aggressive type of skin cancer."
D. Melanoma arises from the squamous cells in the stratum
spinosum."
The answer is B. This is the only correct statement about
melanoma. It can occur anywhere in the body where
there are melanocytes (example: middle layer of the eyes
(uvea), epidermis etc.) and it originates from the
melanocytes.
4. You're providing teaching to a patient diagnosed with squamous cell carcinoma
on the face. In your teaching, you are providing education on how this type of skin
cancer develops. What information will you include in your patient education?*
A. "Squamous cell skin cancer develops in the stratum spinosum layer of the
epidermis and occurs due to mutated keratinocytes."
B. "Squamous cell skin cancer develops in the stratum corneum layer of the
epidermis and occurs due to mutated basal cells."
C. "Squamous cell skin cancer develops in the stratum basale layer of the
epidermis and occurs due to mutated melanocytes."
D. Squamous cell skin cancer develops in the stratum granulosum layer of the
epidermis and occurs due to mutated squamous cells."
The answer is A. Squamous cell skin cancer develops in
the stratum spinosum layer of the epidermis and occurs
due to mutated keratinocytes.
5. Use the
figures to
answer the
next five
questions.
Which figure
represents
basal cell
carcinoma
The answer is A. Figure
1 is basal cell
carcinoma and features
pearly, waxy
appearance with a
slight depressed center
and raised edges.
6. Which figure
represents a skin
lesion that is
mainly found in
older white adults
that can develop
into squamous
cell carcinoma?*
The answer is C. This is known
as actinic keratosis (solar
keratosis). It is precancerous and
can develop into squamous cell
carcinoma. It tends to affect
older white adults and forms in
areas exposed to the sun. It will
appear as scaly, reddened
patches.
7. Which figure
represents squamous
cell carcinoma?
The answer is B. This
figure features
squamous cell
carcinoma because it
has a crusty, scaly
appearance and is
raised.
8. As the nurse
you know that
which figure
represents a type
of skin cancer
that is aggressive
and has the
highest risk of
metastasizing?
The answer is D. Figure 4
represents melanoma. Use the
acronym ABCDE to help you
identify this type of skin cancer.
This lesion is asymmetrical, has
irregular borders, is dark in color,
and has a diameter greater than
6mm. In addition, it has
evolution in that it will increase
in size, color, or shape.
9. Which figure
above is the
MOST common
type of skin
cancer?*
The answer is A. Basal cell
carcinoma is the MOST
common type of skin
cancer and is featured in
figure 1.
10. Identify the patients below who are at a HIGH risk for
developing skin cancer. Select all that apply:*
A. A 22-year-old female who reports using a tanning bed three
times per week.
B. A 55-year-old male with dark skin that reports always wearing
sunscreen while outdoors.
C. A 35-year-old female with light-colored skin and eyes that
reports frequent sunburns as a child.
D. A 29-year-old who reports a family history of melanoma.
The answers are B, C, and E. When educating about how
to identify melanoma using the ABCDE acronym.
A: asymmetrical,
B: borders uneven (dissimilar),
C: color dark or multiple colors, D: diameter greater than
6 mm (NOT 8 mm).
E: evolution (lesion increases in size, shape, color)
Thank you! Have a good one!
