Chapter 24 Skin Cancer and Melanoma – Flashcards
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What is the most common skin cancer and has pearly borders? A. Actinic keratosis B. Basal cell carcinoma C. Malignant melanoma- deadliest D. Squamous cell carcinoma
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B
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Which description characterizes seborrheic keratosis? A. White patchy yeast infection- candidiasis B. Warty, irregular papules or plaques C. Excessive turnover of epithelial cells- psoriasis D. Deep inflammation of subcutaneous tissue- cellulitis
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B
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Which skin condition occurs as an allergic reaction to mite eggs? A. Scabies B. Impetigo C. Folliculitis D. Pediculosis
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A
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objectives
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-describe skin related health promotion practices -explain etiology, clinical manifestations, nursing & collaborative care or dermatologic conditions such as benign & malignant lesions, insect bites, infections , allergic reactions
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health promotion
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-avoidance of environmental hazards (sun, chemicals) -adequate hygiene and nutrition (adequate rest) -skin self- exam
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Environmental Hazards
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-Sun exposure -Irritants and allergens -Radiation -Sleep- restorative to skin -Exercise- increase circulation, dilates blood vessels -Hygiene- use of any soaps, avoid vig scrubbing -Nutrition
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Health Promotion: Sun Exposure
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-Fair skin types (blonde/red hair) -Sun safety guidelines including: (Large brimmed hats, sunglasses, long sleeves, umbrella, SPF) -Sun rays most dangerous between 10 AM-2 PM -SPF of at least 15-30 -Medications- antibiotics (Only tops of fingers were burnt, NSAIDs) -Dark skinned people less susceptible
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check table 24-2
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patho?
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Irritation
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Irritant contact dermatitis- direct chemical injury Allergic contact dermatitis- delayed hypersensitivity response
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Radiation
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X-rays for diagnosis and therapy
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Most common metal allergy:
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nickel, jewelry, belts (nickel), males and females
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health promotion
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sleep, exercise, hygiene, nutrition
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malignant skin neoplasms
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-Most diagnosed cancer -Melanoma or Non-melanoma (neoplasms of epidermis, sun exposed areas)
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Actinic keratosis
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-Most common premalignant skin lesions -Common in older Caucasians -Hyperkeratonic papules and plaques occurring on sun exposed areas -Irregularly shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale or horn -Adherent scale, which returns when removed
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Basal Cell Carcinoma
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-Locally invasive malignancy -Most common type of skin cancer -Do not watch and wait, just remove -Least deadly -Occurs in middle aged to older adults -Caused by sun exposure and genetic skin type -Appears as a small, waxy nodule with a translucent pearly border with telangiectasia -do not watch and wait, just remove -common in face hairline upper lip -EROSION IN MIDDLE!!!
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Squamous Cell Carcinoma
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-potential to metastasize -usually follows excessive sun exposure, irradiation, or trauma causing scarring -pipe, cigar, and cig smoking (can contribute to mouth and lips) -appears as an opaque firm nodule with an indistinct border, scaling, and ulceration -neoplasm, can lead to death if not treated -less common than basal cell -more aggressive- highly
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Dysplastic nevi (DN) = pre-malignant melanoma
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-Risk for melenoma if you have this -Irregular borders, various shades of color -Same ABCDE but less pronounced
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Malignant Melanoma
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Cause unknown -Environmental factors -Genetic factors -Metastisize in any organ- brain and heart -10x higher death rate in caucasians and african americans
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risk factors
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-Red or blonde hair -Light-colored eyes -Fair skin that freckles -Chronic sun exposure -Family history -Suppressive drugs can increase person at risk -UV, tanning beds, and above factors -5-10% had it in the family
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Malignant Melanoma, common sites in women
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back and legs
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Malignant Melanoma, common sites in men
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trunk, head, and neck
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Malignant Melanoma Diagnosis
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-Should NOT be -Shave-biopsied, shave-excised, electrocauterized -MelaFind -Tumor thickness (Breslow measurement, Clark level)
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Breslow
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prognostic factor in melanoma of the skin. It is a description of how deeply tumor cells have invaded.
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clark
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depth and invasion
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thinner
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better to cure
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collaborative care
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-Treatment determined by -Site of original tumor -Stage of the cancer -Patient's age and general health -Includes surgical incision and adjuvant therapy -surgically excise the melenoma -Skin graft to close it -Needs chemo and radiation
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Tumor staging
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-O-IV -Tumor size -Nodal involvement (lymph node) -Metastasis- liver or heart Treatment is palliative -T-N-M- tumor nodal metastasis -Stage 0- confined in one place -100% cureable if found at stage 0
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Bacterial infections
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-Impetigo -Folliculitis -Cellulitis Staph A. Beta strep
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Impetigo
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-bacterial skin infection caused by invasion of the epidermis by staph aureus** or group A beta-hemolytic streptococci** -Itchy, pustule-like lesions with moist honey-colored crusts surrounded by redness -Treated with topical treatment two to three times a day to remove the crusts -Hand hygiene and lesions will heal without scarring** (teach)
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Folliculitis
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-Due to staph aureus -Located in areas subjected to friction, moisture, or rubbing -Common on the scalp, beard, and extremities of men -Tender small pustule at the hair follicle opening with minimal erythema -Warm compresses, hygiene care.
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Cellulitis
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-Inflammation of the subcutaneous tissues often following a break in the skin caused by staph, strep, and h. flu -Intense redness, edema with diffuse border, tenderness, and localized warmth -Immobilization, elevated of affected extremity and systemic antibiotics -Teach hand wash, avoidance -Full course antibiotics -Moist heat
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Herpes simplex virus (HSV), Type 1
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fever blister, cold sore mouth
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Herpes simplex virus (HSV), Type 2
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genital herpes -occurs below the waist -but Can be seen in both places
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Herpes zoster (shingles)
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-Activation of the varicella-zoster virus -Antiviral agents Age of 60 -zoster vaccine
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HSV treatments
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-Treated with application of soothing moist compresses, analgesics, antihistamines for itching, Gabapentin (Neurontin) for post herpetic neuralgia -Antiviral agents -Zoster vaccine
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how to document HSV
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-location, astraform, dermatome, never cross the midline, always unilateral Unilateral at trunk, pain burning before vesicles occur Gavapen- pain
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Viral Infections: Plantar warts
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-Caused by human papilloma virus (HPV) -Treated with topical therapy or cryosurgery
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Fungal infections: Candidiasis
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-Candida albicans -Wet hands, oral mucosa, white plack, satellite lesions on skin
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tinea corporis
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Ringworm- annular
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tinea cruris
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Jock itch- small red scaly patch
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tinea pedis
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Athlete's foot, scaling, blistering, Erythema in between toes
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tinea unguium (onychomycosis)
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Toenail fungal infection
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Skin Infections and Infestations, fungal infections
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-Can occur anywhere Including hair and nails -Antifungal cream/oral meds 6-8 weeks -Look for: (lab values) liver enzymes -LFT- liver function test
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Bites Scabies
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Sarcoptes scabiei Burrows between fingers, wrists*, axillary folds
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Infestations and Insect Pediculosis
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Body lice Head, body, and pubic lice Infestationg of skin by --mites, intense itching, fingers, wrists, axillary folds -Swelling, vesicular formation Eggs- nits
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Allergic contact dermatitis
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Inflammatory skin reaction that results because the skin has come in contact with a specific irritant
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Urticaria
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Allergic response Raised or irregularly shaped wheels
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drug reaction
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Rash of any morphology Drug hypersensitivty PCN vanco
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Atopic dermatitis
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Age 2-6 months old, persists to adulthood A superficial, chronic inflammatory disorder associated with allergy with a hereditary tendency
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Psoriasis
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-chronic, autoimmune dermatitis characterized by silvery, scaling plaques on the elbows, knees, palms, and soles. -Bilateral symmetry -Treated with topical therapy (steroids, retinoid, vitamin D), photo therapy, systemic therapy (methoxtrexate) -Immunosuppressed patients -Acne, psoriasis, Rapid turnover of epithelial cells 15-25 years old
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Acne vulgaris
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-inflammatory disorder of the sebaceous glands and their hair follicles -Treated with antibacterial agents such as benzoyl peroxide, antibiotic therapy or Accutane- make sure not pregnant or intentions
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Seborrheic keratosis
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benign, familial, irregularly round or oval papules or plaques Well defined, looks like it's stuck on
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dermatologic manifestations: endocrine
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-Hypo/hyper- thyroidism, diabetes mellitus, -Addison's disease
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dermatologic manifestations: GI
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IBS, CF
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dermatologic manifestations: Musculoskeletal and connective tissue
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SLE, scleroderma
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dermatologic manifestations: Metabolic
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-vitamin B and C deficiency
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dermatologic manifestations: Immune
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HIV, lymphoma
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dermatologic manifestations: Cardiovascular
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Rheumatic heart disease, PVD, venous ulcers
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dermatologic manifestations: respiratory
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inadequate oxygenation
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dermatologic manifestations: hematologic
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anemia, clotting disorders
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dermatologic manifestations: renal
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CKD
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dermatologic manifestations: Reproductive organs
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syphilis
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dermatologic manifestations: neurologic
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spinal cord trauma, polyneuropathies
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Dermatologic Problems
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-Collaborative therapy -Topical therapy -Phototherapy -Psoralen and UVA light -Radiation therapy -Shrink basal and squamous cell -Laser technology See table 24-12 for skin conditions
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Surgical Therapy
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-Skin scraping -Electrodesiccation -Electrocoagulation -Curettage -Punch biopsy- pretty common, lesions smaller than .5 cm -Cryosurgery- freezing warts -Excision—Mohs procedure
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clean margins=
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no more cancer cells
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Ambulatory and home care:
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Wet dressings Baths Topical medications Pruritus control Prevention of spread Prevention of secondary infections Itching Cool wet towels Cool baths Antihistamines for itching Avoid dryness of skin Avoid vasoldilation- not scrub -> pat dry Good hygience, prevent spread
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Psychologic effects/support
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Reinforce prescribed regimen Support groups Camouflage -hygiene car
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Physiologic effects
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Scarring and lichenification Location of scar secondary infection
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Cosmetic Procedures
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-Elective surgery Many types- face lift, liposuction, laser surgery -Improve body image -Most not covered by insurance and can be painful -Maintain a supportive, nonjudgmental attitude
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Preoperative Management
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Same as prior pre-op care Teach healing time may be up to 1 yr
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Postoperative Management
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Same as post-op care Circulation monitoring Teach for signs/symptoms of infection Supportive Ice
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LPN
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administer prescribed therapies such as dressings and oral or topical medications -monitor the skin for changes in appearance or texture that may indicate worsening of integumentary problem or adverse reactions to treatment Reinforce teaching done by RN
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check
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Consent, realistic expectations for surgery for full healing time and effeccts Monitor for circulation Make sure it's warm, pink, blanches on pressure If not adequate circulation- a DOPPLER Compressive dressings in post op helpful as well
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What is an appropriate intervention to promote debridement and removal of scales and crusts of skin lesions? A. Warm oatmeal baths- for itching, pruritus B. Warm saline dressings C. Cool sodium bicarbonate baths- for itching, pruritus D. Cool magnesium sulfate dressings- has never heard of this
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B
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Which skin conditions are more commonc in immunosuppressed patients (select all that apply)? A. Acne- not typically B. Lentigo (liver spots) C. Candidiasis (yeast infections) D. Herpes Zoster E. Herpes Simplex I F. Kaposi sarcoma - seen in HIV populations
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CDEF
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Which statements characterize malignant melanoma (select all that apply)? A. Lesion is keratotic and firm- actinic keratonsosis, squamous cell B. Neoplastic growth of melanocytes C. Skin cancer with highest mortality rate D. Irregular color and asymmetric shape E. Frequently occurs on previously damaged skin- squamous
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BCD
