Download Skin Cancer Screening

What screening tests are available, cost
What does CDC recommend for scheduling test
What does USPSTF recommend
What does the nation's leading physician organization for that system recommend
(example: American College of Obstetrics and Gynecology ACOG)
What does the screening test exam consist of.
pictures ( if available)
What is considered a negative screening or positive screening
What happens if the results are positive.
List of internet resources which might be helpful for pt education.
let's each choose one game to include (example: cross word or other)
Skin Cancer Screening
All about the skin
The skin is the body’s largest organ, and protects us from heat, sunlight, injury, and
infection. It helps regulate body temperature, stores fat and water, and produces Vitamin
D from sunlight (The Patient Education Institute, 2010a).
The skin is made of two main layers: the outer epidermis and the inner dermis. The
epidermis is made of mostly flat, scaly cells called squamous cells. Underneath the
squamous cells are round cells called basal cells. At the deepest part of the epidermis,
there are cells called melanocytes, which produce melanin (what gives skin its color)
(The Patient Education Institute, 2010a).
The inner layer of skin, the dermis, contains blood and lymph vessels, hair follicles, and
sweat and sebum (oil-producing) glands (The Patient Education Institute, 2010a).
QuickTime™ and a
decompressor
are needed to see this picture.
Skin Cancer
Skin cancer is the most common type of cancer in the United States (National Institutes
of Health [NIH], 2010a). More than 1 million people are diagnosed with skin cancer each
year. The two most common types are basal cell and squamous cell carcinomas, named
for the type of cell in which they begin, and the third type is called melanoma.
Basal and squamous cell carcinomas
Carcinomas are tumors that originate in the lining of organs, such as the skin. Basal cell
carcinomas make up about 90% of all skin cancers. It is slow-growing and almost never
invades surrounding tissues (The Patient Education Institute, 2010a). Squamous cell
carcinomas spread more readily than basal cell carcinomas, so it is important that it be
found and treated early. These two types of skin cancer are usually found on the head,
face, neck, hands, and arms, and can easily be cured through surgical removal when
found early.
Melanoma
The third type, melanoma, does not occur as frequently, but is much more dangerous.
Melanoma causes more than three-quarters of the deaths from skin cancer in the United
States (National Cancer Institute [NCI], 2010a). The rates of melanoma have more than
doubled in the past 20 years (The Patient Education Institute, 2010b). Melanoma
originates in the melanocytes, in the deepest part of the epidermis. Melanoma can be
found on any part of the skin. In general, however, melanoma is found mostly on the
head, neck, and the trunk of men, and on the lower legs in women. Melanoma is
uncommon in people with dark skin, but can be found under the fingernails or toenails, or
on the palms of the hands, or the soles of the feet. The risk of developing melanoma also
increases with age, but can affect any age. It is one of the most common cancers in young
adults (The Patient Education Institute, 2010b).
Melanoma is particularly dangerous because of its tendency to spread, or metastasize.
Once melanoma has entered the lymph nodes, it may travel to any other part of the body,
but usually to the brain, lungs, or liver. Once it has spread, it can be very difficult to
control (The Patient Education Institute, 2010b).
Symptoms
Basal and squamous cell carcinomas
Symptoms of basal cell and squamous cell carcinomas are similar. They are usually a
change in the skin, such as a new growth on the skin that does not heal, and they are
usually not painful (The Patient Education Institute, 2010a). They can have a number of
different appearances, such as shiny, smooth, lumpy, waxy, and pale. They can also
appear as a flat, red, scaly spot. They can develop a scaly crust, or may bleed, especially
when exposed to sun.
QuickTime™ and a
decompressor
are needed to see this picture.
Melanoma
The first sign of melanoma is usually a change in the size, color, or shape of an existing
mole. It may have a black or blue area around it. Doctors look at the symmetry, mole
borders, color, and size to determine the possibility of a malignant mole.
A helpful way to remember this is to assess the ABCD’s of a mole:
A: Asymmetry- melanomas are asymmetrical moles and the two halves of the mole do
not look alike.
B: Border- melanomas have edges that are ragged, notched, blurred, or irregular
C: Color- melanomas have uneven color, from shades of black, brown, and tan. There
may also be areas of white, gray, red, pink, or blue.
D: Diameter- melanomas are usually at least 6 mm or 1/4 inch in diameter (or larger than
the size of a pencil eraser) (The Patient Education Institute, 2010b).
QuickTime™ and a
decompressor
are needed to see this picture.
In advanced melanoma, the mole becomes thick, hard, lumpy, and deep. It may bleed,
ooze, or itch. It usually does not cause pain (The Patient Education Institute, 2010b).
Risk Factors
Anyone can get skin cancer, but there are a few risk factors that can predispose a person
to get skin cancer more readily.







Having a fair complexion, which includes the following:
o Fair skin that freckles and burns easily, does not tan, or tans poorly.
o Blue or green or other light-colored eyes.
o Red or blond hair.
Being exposed to natural sunlight or artificial sunlight (such as from tanning beds)
over long periods of time.
Having a history of many blistering sunburns as a child.
Having several large or many small moles (more than 50).
Having a family history of unusual moles.
Having a family or personal history of melanoma.
Being white and male (NCI, 2010a).
Pros and Cons to Screening
Pros






Skin cancer is 100% curable if found early.
Screening is non-invasive.
A person may self-screen monthly to find any changes in the skin, or new changes
to pre-existing growths.
Self-screening or help from a family member is easy to do.
Screening can be done in conjunction with a doctor’s visit for another reason.
There is no stigma associated with skin cancer screening (Strayer & Schub, 2010).
Cons
There are few disadvantages to skin cancer screening. Some possible disadvantages are:



Overly aggressive treatment of borderline skin changes
False reassurance for those with false-negative screening results who might ignore
further symptoms.
“A longer awareness of the life-threatening disease state as a result of early
diagnosis for those whose prognosis is not improved” (Strayer & Schub, 2010).
Prevention




Sunblock of at least SPF 30 blocks out most of the sun’s UV rays.
Stay out of the sun between 10 am to 3 pm.
Protective clothing, hats, and sunglasses block the sun.
Begin protective skin care in childhood (NCI, 2010a).
Treatment
The best treatment options for all skin cancer types is surgical removal of all the
cancerous tumor. However, in some cases, the cancer has spread, or metastasized, to
other parts of the body. In this case, the cancer may be treated with any combination of
surgery, chemotherapy, biological therapy, or radiation (NCI, 2010c).
QuickTime™ and a
decompressor
are needed to see this picture.
Implications for Nursing: Education, education, education!




Educate patients on the correct use of sunscreen and other protective activities,
such as the use of protective clothing and avoidance of strong sunlight and
tanning beds.
Discuss individualized melanoma risk factors with patients.
Educate patients about abnormal skin changes while you examine their skin.
Encourage self-screening and use of a mirror to view places, such as the back side
of the body.


Encourage parents to become familiar with their children’s skin and to perform
monthly skin screening on their children.
Address the importance of scheduling a clinician appointment promptly after
finding a new growth or noticing changes in an existing growth or mole (Strayer
& Schub, 2010).
Resources
Melanoma Interactive Tutorial
Non-Melanoma Skin Cancer Interactive Tutorial
References
National Cancer Institute. (2010a). Melanoma: pathology [photograph]. Retrieved July
22, 2010, from
http://visualsonline.cancer.gov/searchaction.cfm?keyword=melanoma
National Cancer Institute. (2010b). Skin cancer screening: PDQ. Retrieved July 22, 2010,
from http://www.cancer.gov/cancertopics/pdq/screening/skin/Patient/page2
National Cancer Institute. (2010c). What you need to know about: Melanoma. Retrieved
July 22, 2010, from http://www.cancer.gov/cancertopics/wyntk/melanoma/page16
National Institutes of Health. (2010a). Melanoma. Retrieved July 22, 2010, from
http://www.nlm.nih.gov/medlineplus/melanoma.html
National Institutes of Health. (2010b). Skin cancer. Retrieved July 22, 2010, from
http://www.nlm.nih.gov/medlineplus/skincancer.html
The Patient Education Institute (2010a). Skin cancer non-melanoma: Online tutorial.
Retrieved July 22, 2010, from
http://www.nlm.nih.gov/medlineplus/tutorials/skincancerandmelanoma/htm/_no_
50_no_0.htm
The Patient Education Institute (2010b). Melanoma: Online tutorial. Retrieved July 22,
2010, from
http://www.nlm.nih.gov/medlineplus/tutorials/melanoma/htm/lesson.htm
Strayer, D., & Schub, T. (2010). Melanoma: Early Detection Through Screening.
Retrieved from CINAHL Plus with Full Text database.
[Untitled photo of squamous and basal cell carcinomas]. Retrieved July 22, 2010, from
http://www.shamban-md.com/newsletter/2009-may.htm
Winslow, T. (2009). Mohs surgery: Skin cancer [photograph]. Retrieved July 22, 2010,
from http://visualsonline.cancer.gov/details.cfm?imageid=8261