The start of summer in Australia is an important time for nurses to turn their focus to the skin. Australia has one of the highest skin cancer rates worldwide; with current predictions forecasting at least two out of three Australians will be diagnosed with skin cancer by the age of 70. Luckily, skin cancer is visible, mostly preventable and curable when detected and treated early.
Though the rates of skin cancer diagnoses are forecast to increase, the stable figures for individuals under the age of 45 currently reflect Australia’s long-standing public education on UV (ultra violet) avoidance and protection.
Nurses should expect to care for individuals with sun-damaged skin who have an increased risk of developing skin cancer, possibly “incidental” to their primary reason for care. In addition to the physical concerns, the psychosocial ramifications of skin cancer following diagnosis are well documented. Anxiety and depression may stem from the fear of actual or anticipated disfigurement, multiple surgeries and treatments. Financial costs, disrupted social relationships and impaired lifestyle add to the burden.
Effective nurse participation in skin cancer recognition, prevention and management, as well as patient support and guidance along recognised referral pathways, requires a basic knowledge and understanding of melanoma and non-melanoma skin cancer.
Types of Skin Cancer
The three main types of skin cancer originate from epidermal cell genetic mutation:
Basal Cell Carcinoma
Basal Cell Carcinomas (BCC) derive from stem cells located in the epidermal basal layer or hair follicles.
Squamous Cell Carcinoma
Squamous Cell Carcinomas (SCC) develops from keratinocytes.
Melanoma advances from melanocytes, basal layer pigment producing cells.
BCCs may display a classic rolled edge or small visible blood vessels; alternatively there may be a pink smudge or a pale, firm, scar-like lesion. SCCs, on the other hand, may exhibit a heaped-up border, ulceration or have a keratotic “horn”.
Melanoma may present as a new or changing lesion, usually pigmented, with colour variation and its appearance may differ from other pigmented lesions on the person. BCCs, SCCs and melanomas can present in sub-types. Though each skin cancer has classic characteristics, they may vary from the description usually attributed to it. Specific tumour behaviour, treatment choice and outcome potential also alter with the specific type.
Subtleties in appearance may impact accuracy and timeliness of diagnosis, care flow, health resources and patient morbidity and mortality.
For instance, the ABCDE rule applies for identifying some suspicious pigmented lesions:
- Border irregularity
- Colour variegation
- Diameter > 6 mm
- Evolution or enlarging
However, you must be aware that in paediatrics, nodular or amelanotic melanoma the individual might not present with conventional ABCDE criteria for diagnosing a suspicious lesion or melanoma.
There are a number of risk factors around skin cancer that should also be taken into account.
- Light skin colour, blue or green eyes, blonde or red hair
- Family or personal history of skin cancer
- Sun exposure (main risk) through work and recreation
- A history of sunburns, especially in childhood
- A history of indoor tanning
- Certain types and a large number of moles
- Immune compromise through disease, age or medication compounds other risks
Nurses are well positioned to have a positive impact on community skin cancer awareness and to advise on sun protection and minimisation techniques. Wherever you work as a nurse, you have a role in education, prevention and management around skin cancers.
Greater nurse knowledge and awareness increases vigilance, aids early identification and improves patient outcomes. Irrespective of care context, it is best to approach suspicious or new lesions and non-healing wounds with a level of wariness.
- Clear instruction for checking your own skin:
- The Peter MacCallum Cancer Centre has an interesting nurse education web area: http://www.petermac.org[…]registration
- About the ABCDE Rule:
- Cancer Council Australia. On line learning modules viewed 30 September 2015
- Cancer Council Australia. Skin Cancer Statistics and Issues. Sydney: Cancer Council Australia. [Version URL: http://wiki.cancer.org.au/[…]&oldid=489, cited 2015 Oct 26]. Available from: http://wiki.cancer.org.au/[…]Issues
- Duman, N, Erkin, G, Gököz, O, Karahan, S, Kayıkçıoğlu, AU & Çelik, I 2015, ‘Nevus-associated versus de novo melanoma: Do they have different characteristics and prognoses?’ Dermatopathology, vol.2, no. 1 pp.46–51 DOI: 10.1159/000375490, viewed 4 October 2015 https://www.k[…]0
- Freak, J 2003, ‘Nurses’ role in public education on the risks of skin cancer’ vol. 99, no. 25, viewed 30 September 2015
- Helfrich, YR, Sachs, DL, Voorhees, JJ 2008, ‘Overview of skin aging and photoaging’, Dermatology Nursing, vol. 20, no. 3 viewed 4 October 2015 http://www.scrubsuk.com[…]toaging.pdf
- Hoerter, JD, Bradley, P, Casillas, A, Chambers, D, Weiswasser, B, Clements, L, Gilbert, S & Jiao, A 2012, ‘Does melanoma begin in a melanocyte stem cell?’
Journal of Skin Cancer, Article ID 571087, 9 pages doi:10.1155/2012/571087 viewed 12 October 2015, http://www.hindawi.com/journals/jsc/2012/571087/
- Olsen CM, Williams PF, Whiteman DC 2014, ‘Turning the tide? Changes in treatment rates for keratinocyte cancers in Australia 2000 through 2011.’ J Am Acad Dermatol [Abstract available at http://www.ncbi.nlm.nih.[…]8]
- Radiotis, G, Roberts, N, Czajkowska, Z, Khanna, M & Körner, A 2014, ‘Nonmelanoma skin cancer: Disease-specific quality-of-life concerns and distress’, Oncology Nursing Forum, vol. 41, no. 1, viewed 6 October 2015. http://www.academia.edu[…]distress
- Ratushny, V, Gober, MD, Hick, R, Ridky, TW & Seykora, JT 2012, ‘From keratinocyte to cancer: the pathogenesis and modeling of cutaneous squamous cell carcinoma,’ J Clin Invest. vol. 122 no. 2 pp. 464-472. Doi: 10.1172/JCI57415.
- Siegel, V. (2010). Exploring the role of the nurse in skin cancer prevention. Dermatology Nursing, vol. 4 no. 12, pp. 18-22 viewed 4 October 2015, http://molliesfund.org/[…].pdf