Skin Cancer

In this lesson we’re going to review the basics of skin cancer. As a new grad, you will not be expected to know the ins and outs of oncology or cancer treatments, but there are few important points you will need to know no matter where you work.

So skin cancer, as with all cancers involves excessive and abnormal cell growth, in this case in the epidermal and dermal layers of the skin. They are most commonly caused by exposure to UV rays like the sun or tanning beds. There are three main types - Basal Cell carcinoma, which is the most common and primarily affects the epidermis, squamous cell carcinoma which affects multiple layers and usually ulcerates. And Melanoma, which is the most deadly and most likely to metastasize.

Any time you have a dark spot or lesion on the skin, you need to assess it to determine if it might be cancerous. This is a standard mole or nevus. You can see it’s small, round, symmetrical, is solid brown, flat, and has smooth borders. So - in order to assess one that looks suspicious, we use the mnemonic ABCDE. A stands for Asymmetry - melanoma or other cancerous lesions will be asymmetrical, like you see here. B is borders - the borders will be irregular and jagged. C stands for color - the color will be inconsistent or change colors throughout the lesion. You can see how this one is darker on the sides than in the middle, and it’s super dark right here. D is diameter - anything over 6 mm or the size of a pencil eraser is considered suspicious and should be checked out. And E stands for Elevation or Evolution - the lesion might be raised off the skin, but there are plenty of non-cancerous lesions that are also raised - what really tells us there’s an issue is evolution. Is it evolving? Has it changed in the last 6 months? If so, it needs to be checked out. So those are the ABCDE’s of moles, it’s important that you know and can teach your patients what to look for.

Once we do have a suspicious mole, we’ll get a biopsy to confirm the diagnosis - remember all cancers must be diagnosed with a biopsy. If it is a malignant skin cancer, they can do chemo or radiation, or even surgically remove the lesion if it’s localized. More than anything, it’s important that we teach our patients how to prevent skin cancer in the first place. They need to know their risk factors - being out in the sun a lot is a huge risk factor, and so is frequent use of UV tanning beds. So we teach them to protect their skin. Sunscreen with a high SPF should be worn and reapplied every 2 hours. That’s one thing a lot of people don’t realize is how often it should be reapplied! They should also wear a hat or protective clothing if they’ll be outside and avoid going outside in the middle of the day when the UV rays are the strongest. And, like I said, we also want to teach them to monitor the lesions and notify their provider before it gets too severe. For melanoma, if it metastasizes, it’s one of the hardest cancers to treat in other organs.

This is probably self-explanatory, but our priority concepts for a patient with skin cancer or at risk for skin cancer is going to be tissue/skin integrity, cellular regulation, and health promotion or patient education. Check out the care plan attached to this lesson to learn more.

This is pretty straight forward, but let’s just recap quickly. Skin cancer is an abnormal growth of cells in the skin, most commonly caused by UV exposure. We use the ABCDE mnemonic to assess and monitor any suspicious lesions. That stands for asymmetry, borders, color, diameter (remember - think pencil eraser), and elevation or evolution. We need to educate our patients on how to protect themselves from UV exposure because in most cases, skin cancer is preventable.

So that’s the basics of skin cancer. If you go to work on an oncology unit, you’ll learn more. Either way, make sure you’re protecting yourself from the sun, too! No, go out and be your best selves today. And, as always, happy nursing!