Nursing Care Plan for Skin cancer – Melanoma, Basal Cell Carcinoma, Squamous Cell Carcinoma

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

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

• https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/diagnosis-treatment/drc-20354193
• https://www.medicinenet.com/skin_cancer_overview/article.htm#when_is_a_mole_dangerous_or_high_risk_for_becoming_a_skin_cancer
• https://www.medicinenet.com/script/main/art.asp?articlekey=43077