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SKIN CANCER

Primary cause
• Overexposure to the sun is a
primary cause ; other causes
and conditions that place the
individual at risk include
chronic skin damage from
repeated injury and irritation ,
an inherited genetic mutation
,ionizing radiation ,light-
skinned race , age older than
60 years ,an outdoor
occupation and exposure to
chemical carcinogens.
• Diagnosis is confirmed by skin
biopsy.


SIGN AND SYMPTOMS
• There are a variety of
different skin cancer
symptoms. These include
changes in the
 skin that do not heal
 ulcering in the skin,
 discolored skin
 changes in existing moles
 such as jagged edges to
the mole
 and enlargement of the
mole.

Ultraviolet radiation from sun exposure is the primary cause
of skin cancer. Other factors that play a role include:
• Smoking tobacco
• HPV infections increase the risk of squamous cell
carcinoma.
• Some genetic syndromes including congenital
melanocytic nevi syndrome which is characterized by
the presence of nevi (birthmarks or moles) of varying
size which are either present at birth, or appear within
6 months of birth. Nevi larger than 20 mm (3/4") in size
are at higher risk for becoming cancerous.
• Chronic non-healing wounds. These are
called Marjolin's ulcer based on their appearance, and
can develop into squamous cell carcinoma.
• Ionizing radiation environmental carcinogens artificial
UV radiation (e.g. tanning beds), aging, and light skin
color. n cancer.
• The use of many immunosuppressive medication
increase the risk of skin cancer. Cyclosporin A,
a calcineurin inhibitor for example increases the risk
approximately 200 times, and azathioprine about 60
times.


Appearance of Skin Cancer Lesions

• Basal cell carcinoma
• Waxy border
• Papule,red,central
crater
• Metastasis is rare


TYPES

BASAL CELL-Basal cell cancer arises
from the basal cells contained in
the epidermis ;metastasis is rare
but underlying tissue
destruction can progress to
organ tissue.
Squamous cell-Squamous cell
cancer is a tumor of the
epidermal keratinocytes and can
infiltrate surrounding structures
and metastasize to lymph
nodes.
Melanoma –Melanoma may occur
any place on the body especially
where birthmarks or new moles
are apparent; it is highly
metastatic to the brain ,lungs
,bone and liver, with survival
depending on early diagnosis
and treatment


Squamous cell Carcinoma

• Oozing,
bleeding,crusting lesion
• Potentially metastatic
• Larger tumors
associated with a higher
risk for metastasis


Melanoma

• Irregular , circular,
bordered lesion with
hues of tan ,black,or
blue
• Rapid infiltration into
tissue ,highly metastatic


Classification

• Histopathology-Breast cancer is usually classified
primarily by its histological appearance. Most breast
cancers are derived from the epithelium lining the
ducts or lobules, and these cancers are classified
as ductal or lobular carcinoma.

Grade
• Grade-Grading compares the appearance of the breast cancer cells to the appearance of normal breast
tissue. Normal cells in an organ like the breast become differentiated, meaning that they take on specific
shapes and forms that reflect their function as part of that organ. Cancerous cells lose that differentiation.
In cancer, the cells that would normally line up in an orderly way to make up the milk ducts become
disorganized. Cell division becomes uncontrolled. Cell nuclei become less uniform. Pathologists describe
cells as well differentiated (low grade), moderately differentiated (intermediate grade), and poorly
differentiated (high grade) as the cells progressively lose the features seen in normal breast cells. Poorly
differentiated cancers (the ones whose tissue is least like normal breast tissue) have a worse prognosis.

Stage
• Breast cancer staging using the TNM system is based
on the size of the tumor (T), whether or not the
tumor has spread to the lymph nodes (N) in the
armpits, and whether the tumor has metastasized
(M) (i.e. spread to a more distant part of the body).
Larger size, nodal spread, and metastasis have a
larger stage number and a worse prognosis.



– Stage 0 is a pre-cancerous or marker condition,
either ductal carcinoma in situ (DCIS) or lobular carcinoma
in situ (LCIS).
– Stages 1–3 are within the breast or regional lymph nodes.
– Stage 4 is 'metastatic' cancer that has a less favorable
prognosis.

Receptor status
• Breast cancer cells have receptors on their surface
and in their cytoplasm and nucleus. Chemical
messengers such as hormones bind to receptors,
and this causes changes in the cell. Breast cancer
cells may or may not have three important
receptors: estrogen receptor (ER), progesterone
receptor (PR), and HER2.


DNA assays

• DNA testing of various types including DNA
microarrays have compared normal cells to breast
cancer cells. The specific changes in a particular
breast cancer can be used to classify the cancer in
several ways, and may assist in choosing the most
effective treatment for that DNA type.


Assessment

• Change in color ,size, or shaped of preexisting
lesion
• Pruritus
• Local soreness

Interventions

• Instruct the client regarding the risk factors and preventive
measures.
• Instruct the clients to perform monthly self-skin assessment and
to monitor for lesions that do not heal or that change
characteristics.
• Advise the client to have moles or lesions removed that are
subject to chronic irritation.
• Advise the client to avoid contact with chemical irritants .
• Instruct the client to wear layered clothing and use sunscreen
lotions with an appropriate skin protection factor when outdoors.
• Instruct the client to avoid sun exposure between 10am and 4pm.
• Management may include surgical or non surgical interventions ; if
medications is prescribed provide instructions about its use.
• Assist with surgical management, which may include cryosurgery,
curettage and electrodessication , surgical excision of the lesion.


PREVENTION

• Sunscreen is effective and thus recommended to prevent
melanoma

and squamous cell carcinoma.
• There is little evidence that it is effective in preventing basal cell
carcinoma.
• Other advice to reduce rates of skin cancer includes:
• avoiding sun burning, wearing protective clothing, sunglasses and
hats, and attempting to avoid sun exposure or periods of peak
exposure.
• The risk of developing skin cancer can be reduced through a
number of measures including: decreasing indoor tanning and
mid day sun exposure, increasing the use of sunscreen, and
avoiding the use of tobacco products.
• There is insufficient evidence either for or against screening for
skin cancers.
• Vitamin supplements and antioxidant supplements have not
been found to have an effect in prevention
• Evidence for a benefit from dietary measures is tentative.


MANAGEMENT

• Treatment is dependent on type of cancer, location
of the cancer, age of the patient, and whether the
cancer is primary or a recurrence.
• Treatment is also determined by the specific type of
cancer.
• Topical chemotherapy might be indicated for large
superficial basal cell carcinoma for good cosmetic
outcome, whereas it might be inadequate for
invasive nodular basal cell carcinoma or
invasive squamous cell carcinoma.

• For low-risk disease, radiation therapy
(external beam
radiotherapy or brachytherapy), topical
chemotherapy (imiquimod or 5-fluorouracil)
and cryotherapy (freezing the cancer off) can
provide adequate control of the disease; both,
however, may have lower overall cure rates
than certain type of surgery.
Mohs' micrographic surgery
• Mohs' micrographic surgery (Mohs surgery)- is a
technique used to remove the cancer with the least
amount of surrounding tissue and the edges are
checked immediately to see if tumor is found. This
provides the opportunity to remove the least
amount of tissue and provide the best cosmetically
favorable results. This is especially important for
areas where excess skin is limited, such as the face.