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 (CC 2020). 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 (ultraviolet) avoidance and protection (CC 2020).
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:
Melanomas advance from melanocytes, basal layer pigment-producing cells.
Skin Cancer Appearances
BCCs may display a classic rolled edge or central indentation; alternatively, there may be a pearly bump, red patch, pink growth or a pale, firm, scar-like lesion. SCCs, on the other hand, often appear as a scaly lump that ulcerates (Skin Cancer Foundation 2020). They may also present as a keratotic horn (Oakley 2015).
Melanoma may present as a new or changing lesion, usually pigmented, with colour variation. Its appearance may differ from other pigmented lesions on the person (CC 2019). 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 them. Specific tumour behaviour, treatment choice and outcome potential also depend on 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:
Diameter > 6 mm; and
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 or a large number of moles; and
Immunocompromise due to disease, age, medication compounds or other factors.
(Mayo Clinic 2019)
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 the education, prevention and management of 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.
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, viewed 4 October 2015, https://www.karger.com/Article/Pdf/375490
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, viewed 12 October 2015, https://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, https://pubmed.ncbi.nlm.nih.gov/24685358/