Focus on Skin Cancer: An Overview
Published on the 08 November 2015
Published on the 08 November 2015
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.
The three main types of skin cancer originate from epidermal cell genetic mutation:
Basal Cell Carcinomas (BCC) derive from stem cells located in the epidermal basal layer or hair follicles.
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:
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.
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.
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Jan Riley is a specialist dermatology nurse based in regional New South Wales, Australia. Her postgraduate studies include a Certificate in Dermatology Nursing (USA), Master of Nursing (NP) and Certificates in Dermoscopy and Skin Cancer Medicine. Driven by a passion for “all things skin”, Jan is a staunch and passionate mentor and advocate, who is always ready and willing to share knowledge and inspire nurses to understand skin’s impact on daily lives. Her active participation in a range of professional activities has greatly assisted to raise the profile of dermatology and skin disease in the community. Jan currently develops and presents skin education modules through a co-directed nurse education company (Dermatology Nurse Education Australia) for nurses across all areas of care delivery.