Skin Cancer and Other Skin Problems

Skin Cancer and Other Skin Problems 150 150 Tony Guo

Skin Cancer and Other Skin Problems

 

Lesion distribution terminology

  • Annular – Circular, begins in center and spreads to periphery (e.g., tinea corporis [ringworm])
  • Asymmetric – Unilateral distribution 
  • Confluent – Merging together (e.g., urticaria [hives])
  • Discrete – Distinct individual lesions that remain separate (e.g., acne)
  • Gyrate – Twisted, coiled spiral, snakelike
  • Grouped – Clusters of lesions (e.g., vesicles of contact dermatitis)
  • Localized – Limited areas of involvement that are clearly defined (confined to one area)
  • Polycyclic – Annular lesions grow together (e.g., psoriasis)
  • Solitary – Single lesion
  • Symmetric – Bilateral distribution
  • Zosteriform – Linear arrangement along a dermatome area (e.g., herpes zoster)

 

Assessment variation in light and dark-skinned person

Condition Light skin Dark skin
Cyanosis Grayish blue tone, especially in nail beds, earlobes, lips, mucous membranes, palms, and soles Ashen or gray color most easily seen in the conjunctiva of the eye, mucous membranes, and nail beds
Ecchymosis Dark red, purple, yellow, or green color, depending on age of bruise Purple to brownish black. Difficult to see unless occurring in an area of light pigmentation
Erythema Reddish tone, possibly accompanied by increased skin temperature secondary to localized inflammation Deeper brown or purple skin tone with evidence of increased skin temperature secondary to inflammation
Jaundice Yellowish color of skin, sclera, fingernails, palms, and oral mucosa Yellowish green color most obviously seen in sclera of eye (do not confuse with yellow eye pigmentation, which may be evident in dark-skinned patients), palms, and soles
Pallor Pale skin color that may appear white or ashen; also evident on lips, nail beds, and mucous membranes Lack of underlying red tone in brown or black skin. In light-skinned African Americans, yellowish brown skin. In dark-skinned African Americans, ashen or gray skin
Petechiae Lesions appearing as small, reddish purple pinpoints, best observed on abdomen and buttocks  Difficult to see. May be evident in the buccal mucosa of the mouth or conjunctiva of the eye
Rash May be visualized and felt with light palpation Not easily visualized, but may be felt with light palpation
Scar Generally heals, showing narrow scar line Higher incidence of keloid development, resulting in a thickened, raised scar

 

Health promotion

  • Avoiding environmental hazards
  • Adequate hygiene and good nutrition
  • Skin self-examination
  • Periodic professional exams for areas difficult to see
  • Environmental Hazards
    • Sun exposure
      • Ultraviolet (UV) rays-
  • UVA- tanning
  • UVB- sunburn
  • Other factors include high altitude, being in snow, and tanning booths
  • Sun safety
  • Irritants and allergens
  • Radiation
  • Sleep
    • Adequate rest increases the patient’s ability to tolerate itching, thereby decreasing skin damage from the resultant scratching
  • Exercise
    • Increases circulation and dilates the blood vessels
    • It’s psychologic effects can improve one’s appearance and mental outlook
  • Hygiene
    • The normal acidity of the skin and perspiration protect against bacterial overgrowth.
    • Most soaps are alkaline and neutralize the skin surface, leading to a loss of protection.
    • Skin and hair must be washed often enough to remove excess oil and excretions and to prevent odor. 
    • Older persons should avoid harsh soaps and shampoos and frequent bathing because of the dryness of their skin and scalp.
  • Nutrition
    • Vitamin A: necessary for normal wound healing
    • Vitamin B complex: Essential for complex metabolic functions. Deficiencies of niacin and pyridoxine (B6) manifest as dermatologic symptoms such as erythema, bullae, and seborrhea-like lesions
    • Vitamin C: Essential for connective tissue formation and normal wound healing. Absence of vitamin C causes symptoms of scurvy such as bleeding gums
    • Vitamin D3: Essential for bone health
    • Vitamin K: Essential for synthesizing blood clotting factors

Assessment abnormalities

Alopecia  Loss of hair (localized or general) Heredity, friction, rubbing, traction, trauma, stress, infection, inflammation, chemotherapy, pregnancy, emotional shock, tinea capitis, immunologic factors
Angioma Tumor consisting of blood or lymph vessels Normal increase in incidence with aging, liver disease, pregnancy, varicose veins
Carotenemia (carotenosis) Yellow discoloration of skin, no yellowing of sclerae, most noticeable on palms and soles Vegetables containing carotene (e.g., carrots, squash), hypothyroidism
Comedo (acne lesion) Enlarged hair follicle plugged with sebum, bacteria, and skin cells; can be open (blackhead) or closed (whitehead) Heredity, certain drugs, hormonal changes with puberty and pregnancy
Cyanosis Slightly bluish gray or dark purple discoloration of the skin and mucous membranes caused by excessive amounts of reduced hemoglobin in capillaries Cardiorespiratory problems, vasoconstriction, asphyxiation, anemia, leukemia, and malignancies
Cyst Sac containing fluid or semisolid material Obstruction of a duct or gland, parasitic infection
Ecchymosis Large, bruise-like lesion caused by collection of extravascular blood in dermis and subcutaneous tissue Trauma, bleeding disorders
Erythema  Redness occurring in patches of variable size and shape  Heat, certain drugs, alcohol, ultraviolet rays, any problem that causes dilation of blood vessels in the skin
Hematoma  Extravasation of blood of sufficient size to cause visible swelling Trauma, bleeding disorders 
Hirsutism  Male distribution of hair in women  Abnormality of ovaries or adrenal glands, decrease in estrogen level, familial trait
Hypopigmentation Loss of pigmentation resulting in lighter patches than the normal skin Chemical agents, nutritional factors, burns, inflammation, infection
Intertrigo  Dermatitis of overlying surfaces of the skin  Moisture, irritation, obesity; may be complicated by Candida infection 
Jaundice  Yellow (in white patients) or yellowish brown (in African Americans) discoloration of the skin, best observed in the sclera, secondary to increased bilirubin in the blood Liver disease, red blood cell hemolysis, pancreatic cancer, common bile duct obstruction
Keloid  Hypertrophied scar beyond wound margins  Predisposition more common in African Americans
Lichenification Thickening of the skin with accentuated normal skin markings Repeated scratching, rubbing, and irritation usually as a result of pruritus or neurosis
Mole (nevus)  Benign overgrowth of melanocytes  Defects of development; excessive numbers and large, irregular moles; often familial
Petechiae  Pinpoint, discrete deposits of blood <1-2 mm in the extravascular tissues and visible through the skin or mucous membrane Inflammation, marked vasodilation, blood vessel trauma, blood dyscrasia that results in bleeding tendencies (e.g., thrombocytopenia)
Telangiectasia Visibly dilated, superficial, cutaneous small blood vessels, commonly found on face and thighs Aging, acne, sun exposure, alcohol, liver failure, corticosteroids, radiation, certain systemic diseases, skin tumors
Tenting Failure of skin to return immediately to normal position after gentle pinching Aging, dehydration, cachexia
Varicosity  Increased prominence of superficial veins  Interruption of venous return (e.g., from tumor, incompetent valves, inflammation), commonly found on lower legs with aging
Vitiligo Complete absence of melanin (pigment) resulting in chalky white patch  Autoimmune, familial, thyroid disease

 

Non-melanoma Skin cancers

  • Actinic keratosis
    • Premalignant skin lesions
  • Basal cell carcinoma
    • Most common type of skin cancer
    • Least deadly
  • Squamous cell carcinoma
    • Potential to metastasize
    • Pipe, cigar, and cigarette smoking
    • Immunosuppression leads to a dramatic increase in the incidence

Malignant melanoma

  • Cause unknown
    • Environmental factors
    • Genetic factors
  • Risk factors
    • Red or blonde hair
    • Light-colored eyes
    • Fair skin that freckles
    • Chronic sun exposure
    • Family history
  • ABCDE Rule
    • Asymmetry
    • Border irregularity
    • Color change
    • Diameter >6 mm
    • Evolving in appearance
  • Interprofessional Care
    • Treatment determined by
    • Site of original tumor
    • Stage of the cancer
    • Patient’s age and general health
    • Includes wide surgical incision and adjuvant therapy
  • Tumor staging
    • O to IV
    • Based on tumor size, nodal  involvement, and  metastasis

 

Diagnostic and surgical therapy

  • Skin scraping
    • Obtain a sample of surface cells (stratum corneum) for microscopic inspection and diagnosis
  • Electrodessication/Electrocoagulation
    • The heat created from electrical energy, burns and destroys tissue
  • Curettage
    • The removal and scooping away of tissue using an instrument called a curette
  • Punch biopsy
    • To obtain a tissue sample for histologic study or to remove small lesions
  • Cryosurgery
    • Destroying epidermal lesions by using subfreezing temperature
  • Excision—Mohs procedure

 

Nursing Management

  • Prevention of spread
  • Prevention of secondary infections
  • Specific skin care
    • Wet compresses
    • Baths
    • Topical medications
  • Control of pruritus
    • Break the itch/scratch cycle
    • Cool environment
    • Hydration, wet compresses, moisturizers
    • Topical drugs
  • Cosmetic procedures
    • Topical procedures
    • Injection
    • Elective surgery
      • Laser surgery
      • Face lift
      • Liposuction

 

Nursing management

  • Preoperative management
    • Informed consent
    • Patient teaching 
  • Postoperative management
    • Pain management
    • Monitor for signs of infection and adequate circulation

 

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