CANCER

Skin Cancer
is an abnormal growth of skin cells in the
epidermis caused by unrepaired DNA damage
that triggers mutations.

it develops in the skin that has been subjected to

sunlight.
 Etiology
Too much exposure to UV rays from the sun

Use of tanning beds

 3 TYPES OF SKIN CANCER
1. BASAL CELL CARCINOMA (MOST COMMON FORM OF SKIN
CANCER)

-are abnormal uncontrolled growths that arise from the

skin’s basal cells in the outermost layer of skin.

-Most often develop on skin areas typically exposed to the

sun, especially the face, ears, neck, scalp, shoulders and
back.
Symptoms
-A shiny, skin-colored bump (translucent)
-A brown, black or blue lesion
-A flat, scaly patch with a raised edge.
-A white, waxy, scar-like lesion without a clearly defined
border.

Causes
A change in the DNA causes basal cell carcinoma due to
overexposure to UV rays from the sun or tanning beds
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 2. SQUAMOUS CELL CARCINOMA

-is an uncontrolled growth of abnormal cells arising from

the squamous cells in the outermost layer of skin

-Common on sun-exposed areas such as the ears, face,

scalp, neck and hands including wrinkles and age spots

-A common type of skin cancer but this can sometimes grow

rapidly and metastasize if not detected and treated early.
Symptoms
-A firm bump on the skin, called a nodule. t can look pink, red, black
or brown, depending on skin color.
-A flat sore with a scaly crust.
-A new sore or raised area on an old scar or sore.
-A rough, scaly patch on the lip that may become an open sore.
-A sore or rough patch inside the mouth.
-A raised patch or wart like sore on or in the anus or on the genitals.

Causes
caused by a genetic mutation that leads to an overproduction of
squamous cells near the top layer of your epidermis
 3. MELANOMA
- is a cancer that develops from melanocytes, the skin cells that
produce melanin pigment, which gives skin its color.

- it often resemble moles and sometimes may arise from them.

They can appear on any area of the body, even in areas that are not
typically exposed to the sun.

- According to the Skin Cancer Foundation, melanoma is the most

dangerous of the three most common forms of skin cancer.
Melanomas can be curable when caught and treated early. In 2023,
melanoma is projected to cause about 7,990 deaths.
 Risk Factors
Adults <30 years and >50 years of age; risk increases with age
Family history of skin cancer
Having a large number of nevi (i.e., moles) or having dysplastic nevi
(i.e., atypical, large moles)
History of heavy ultraviolet light exposure (e.g., sun exposure,
tanning beds, sun lamps)
History of sunburns Immune suppression (e.g., acquired immune
deficiency syndrome) Males
People who have blond or red hair
People who have blue or green eyes
People who are light skinned, particularly with skin that burns,
freckles, or reddens easily
Personal prior history of skin cancer
One or more of the following surgical procedures
may be used to treat basal cell carcinoma,
squamous cell carcinoma of the skin, or actinic
keratosis. Laser surgery is rarely used to treat
basal cell carcinoma
 Freezing/Cryosurgery
Cryosurgery is the use of extreme cold in surgery to destroy
abnormal or diseased tissue
Simple Excision
The tumor, along with some of the normal tissue around it, is
cut from the skin
Mohs Micrographic surgery:
The tumor is cut from the skin in thin layers. The edges of
the tumor and each layer of tumor is removed are viewed
through a microscope. Layers continue to be removed until
no more cancer cells can be seen. This type of surgery
removes as little normal tissue as possible. (Face, finger,
genital)
 Shave Incision:
The abnormal area is shaved off the surface of the skin with a small
blade
Curettage/electrodessication
The tumor is cut from the skin using a curette (sharp, spoon-shaped
tool). Needle-shaped electrode is the used to treat the area with an
electric current that stopes the bleeding and destroys cancer cells
that may remain at the edge of the wound.
Laser Surgery
Uses laser beams (a nerrow beam of light) as a knife to make a
bloodless cuts in the tissues/remove surface lesion such as tumor
Dermabrasion
Removal of top layer of skin using a rotating wheel or small particles
to rub away skin cells
 Radiation therapy
A cancer treatment that uses high-energy X-rays or other types of
radiation to kill cancer cells or keep them from growing.
Chemotherapy
It is a cancer treatment that uses drugs to stop the growth of
cancer cells, either by killing the cells or by stopping them from
dividing.
Photodynamic therapy
A cancer treatment that uses a drug and a certain type of light to kill
cancer cells. It is also used to treat actinic keratoses.
. Immunotherapy
A treatment that uses the patient’s immune system to fight cancer.
Pharmacological Management
1. Imiquimod
a. Basal cell carcinoma that is superficial. It is used
in immunocompetent adults. This use is approved for the
Aldara brand of imiquimod.
2. Cemiplimab-rwlc
a. Cemiplimab-rwlc is a type of drug called an immune
checkpoint inhibitor (a type of immunotherapy).
b. It is used in patients whose cancer cannot be removed
by surgery or has spread after treatment with hedgehog
pathway inhibitor therapy or if hedgehog pathway
inhibitor therapy cannot be used (Basel Cell)
Pharmacological Management
3. Pembrolizumab
a. monoclonal antibody that binds to the protein PD-1 on the
surface of immune cells called T cells. It works by keeping cancer
cells from suppressing the immune system.
b. Pembrolizumab is used in patients whose cancer cannot be cured with surgery
or radiation therapy.(cutenious squamous cell)
4. Ipilimumab
a. Ipiliamumab is used alone to help prevent melanoma from coming back after
surgery to remove melanoma in the skin and lymph nodes.
b. Ipilimumab is used in alone or with nivolumab in adults and
alone in children aged 12 years and older whose cancer cannot
be removed by surgery or has spread to other parts of the body.
Health Teaching
 Preventing Skin Cancer
Minimize sun exposure: To the extent possible, avoid sun
between the hours of 10 AM and 4 PM. Wear protective clothing
(e.g., long-sleeved clothing, broad brimmed hats).
Seek shady areas when outdoors.
Wear sunglasses when outdoors to protect the sensitive skin
around the eyes.
Use caution around snow and water because of reflective sun
rays.
Use sunscreen: Use a sunscreen with a sun protection factor
(SPF) of 15 or higher that protects against both ultraviolet-A
(UVA) and ultraviolet-B (UVB) rays.
 Preventing Skin Cancer
Apply generously 20 minutes prior to sun exposure (e.g., going
outdoors).
Reapply every 2 hours, or immediately after swimming.
Use lip balm with SPF of 15 or higher.
Do not use artificial ultraviolet sources (e.g., tanning beds and
booths).
Check your skin regularly: Perform self-examination monthly.
Schedule an examination by primary provider yearly, if over the
age of 50 years.
Strengthen your immune system: Do not smoke/quit smoking.
 6 Tests for Diagnosing Melanoma

Regular screenings and prompt medical attention can

significantly increase the chances of successful intervention
and improved prognosis.
Here is a list of common tests used for melanoma diagnosis:

SKIN EXAMINATION (VISUAL INSPECTION)

helps identify abnormalities or conditions affecting the skin.

It involves a visual inspection of the skin's appearance, texture,
and any notable changes.
The test aids in the melanoma diagnosis of skin disorders,
infections, and skin cancer.
detects skin abnormalities and changes by visually examining the
skin surface. It helps identify potential abnormalities and
melanoma diagnosis for further investigation.
 DERMATOSCOPY (SKIN SURFACE MICROSCOPY)
utilizes a device to magnify skin lesions for enhanced
examination.
It helps in the early detection of skin cancers, including
melanoma.
aids in distinguishing benign lesions from potentially malignant
ones.
examines skin lesions to detect abnormalities accurately. It
provides high-accuracy results, aiding dermatologists in
melanoma diagnosis effectively.
 BIOPSY (TISSUE SAMPLING)

Removal of suspicious skin tissue for further analysis.

Helps determine if the skin lesion is cancerous.
Different types of biopsies include punch, excisional, and
incisional.
involves the surgical removal of suspicious skin tissue for
laboratory analysis. It helps confirm the presence of abnormal
cells, aiding in melanoma diagnosis of melanoma.
 SENTINEL LYMPH NODE BIOPSY
Identifies the first lymph node that cancer is likely to
spread to.
Helps determine the extent of melanoma and guide
treatment decisions.
Involves removing and examining the sentinel lymph node
for cancer cells.
 IMAGING TESTS

aid in evaluating the spread and staging of melanoma.

Common imaging tests include CT scan, MRI, and PET scan.
They provide detailed images of internal organs and lymph
nodes for cancer detection.
Imaging tests, also known as diagnostic imaging, provide detailed
images to evaluate spread and staging of melanoma. They aid in
detecting and evaluating the presence, location, and extent of
disease.
 BLOOD TESTS (LDH, S100B)
Blood tests such as LDH and S100B are used to assess
melanoma progression and detect metastasis.
Elevated levels of LDH and S100B may indicate more advanced
stages of melanoma.
These blood tests are helpful in monitoring treatment response
and disease recurrence.
Blood tests (LDH, S100B) assess biomarkers in the blood for
diagnostic evaluation. They provide valuable information based on
reference ranges, aiding in accurate interpretation and guiding
medical interventions.
Nursing intervention
 Assessment

Assess the patient’s skin

Interview patients or family members regarding changes to the

lesions or appearance of the skin.

Obtain history regarding incidents of sunburn, frequency of sun

exposure or had a family history of skin cancer
 If surgically removal was performed

inspect incision for signs of infection or bleeding

Instruct client to take the medication prescribed by the doctor

Clean the skin with antimicrobial soap

Protect the skin from overexposure to light sources

Patients who will undergo radiation therapy

Assess the skin over the treatment area for redness, irritation or
signs of infection

Inform client that radiation therapy tend to cause fatigue

Assess signs of infection or other adverse reaction of radiarion

therapy