Pathophysiology
Skin cancer is an uncontrolled growth of abnormal skin cells. There are three main types of skin cancers: Basal cell carcinoma is the most common, squamous cell carcinoma (also common) and melanoma (less common, more dangerous). Other conditions that are considered to be precancerous as they can develop into cancer include: actinic keratosis and atypical moles. About 90% of nonmelanoma skin cancers are related to UV exposure, either from the sun or from tanning beds. A person’s risk for melanoma doubles if they have had more than five severe sunburns.
Etiology
UV radiation from the sun or tanning beds is the main cause of mutations in the DNA of skin cells which leads to skin cancers. Cumulative UV exposure over time may result in nonmelanoma cancers, while episodes of severe sunburns before the age of 18 can result in melanoma later in life. Family history of skin cancer and immunosuppressant drugs increase risk of developing skin cancers. Other, less likely causes, may be repeated x-ray exposure, scars from burns or occupational exposure to chemicals (arsenic).
Desired Outcome
Patient will be free from skin cancers, patient is educated on prevention of skin cancers, patient will be free from complications or metastasis
Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma Nursing Care Plan
Subjective Data:
- Itching
- Painful bumps on skin
Objective Data:
- Shiny pink, red or pearly bumps on skin
- Skin growths with raised borders that are crusty in the center
- White, yellow or waxy area with irregular borders (may resemble a scar)
- Open sore that does not go away (weeks)
- Raised growth with rough surface
- Wart-like growth
- Suspicious Mole (ABCDE)
- Asymmetry
- Borders
- Color
- Diameter
- Elevation / Evolution
Nursing Interventions and Rationales
- Assess skin from head to toe; note areas of suspected skin cancers and their size and characteristics
Get baseline data to determine if growth continues to spread or if treatment is effective
- Prepare patient and assist with biopsies of skin lesions
Most biopsies will be performed by punch or scalpel;
- Assess and manage pain as necessary
Patients may experience pain following a procedure or chemotherapy
- Monitor for signs of infection following biopsy or excision
- Biopsies may be followed with electric current cauterization, but may result in an open wound that can become infected.
- Following excision and curettage, monitor for draining of pus, odor or areas that do not show signs of healing
- Apply or administer medications as appropriate
- Topical medications
- Medications for advanced cancer (vismodegib, sonidegib)
Superficial basal cell carcinoma often only requires topical medications for treatment, however more advanced cancers, melanomas or with metastases, medication may be required, especially if other treatments have not been effective.
- Monitor vital signs; changes in skin
Watch for signs of adverse reactions to medications given
- Prevention education for patients and their families
- Avoidance of extended UV exposure
- Use daily sunscreen
Prevention of further cancers or development of new cancer is important for patients and their families.
- Educate patient on how to evaluate suspicious moles using ABCDE mnemonic
Patients can easily self monitor any suspicious moles and report any changes or developments to their primary care provider or dermatologist.
References
Cornell Note-Taking System Instructions:
- Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
- Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column. Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory. Also, the writing of questions sets up a perfect stage for exam-studying later.
- Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas indicated by the cue-words.
- Reflect: Reflect on the material by asking yourself questions, for example: “What’s the significance of these facts? What principle are they based on? How can I apply them? How do they fit in with what I already know? What’s beyond them?
- Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a great deal for current use, as well as, for the exam.
For more information, visit www.nrsng.com/cornell
