Nurse Practitioner, Dermatology

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1 Melissa O Neill, O MS, APRN Nurse Practitioner, Dermatology

2

3 Three Types of Skin Cancer > Basal Cell Carcinoma > Squamous Cell Carcinoma > Malignant Melanoma

4 Basal Cell Carcinoma > Most common skin cancer > A new spot or bump that is getting larger > Sore that does not heal > Pink, red, shiny, translucent bump > May have irregular blood vessels > May appear pressed down > Sometimes may bleed following minor trauma

5 Basal Cell Carcinoma > Basal cell carcinoma Most common Local spread Cured Cured with surgery

6 Squamous Cell Carcinoma > Second most common form of skin cancer > Bump with rough surface > Flat, red, scaly patch > Face, Ears, Lips, Hands or Arms

7 Squamous Cell Carcinoma > Squamous cell carcinoma Very common Some distant spread (5%) Surgery (local), chemotherapy (distant)

8 Types of Skin Cancer (cont) > Melanoma Increasingly common About 55,000 new cases every year Most types spread readily Most serious type of skin cancer About 1 in 7 melanoma patients die of their disease Risk rising dramatically

9 Lifetime Risk of Developing Melanoma in the US :50 Lifetime Risk :250 1:150 1:135 1: :1500 1: Rigel DS, Carucci JA. CA Cancer J Clin. 2000;50: American Cancer Society. Cancer Facts & Figures 2003.

10

11 What Does Melanoma Look Like?

12 Malignant Melanoma

13 Melanoma and Skin Cancer Risk Factors > Environmental Excess sun exposure and exposure to UV radiation >3 3 blistering sunburns during childhood Actinic keratosis Use of sun lamps, tanning beds > Hereditary Fair complexion Moles History of cancer, especially melanoma

14 Prevent Skin Cancer-Be SunAWARE > A -Avoid unprotected UV exposure at all times > W -Wear sun protective clothing, hats, sunglasses > A -Apply sunscreen with SPF 30 or greater > R -Routinely check your whole body for changes > E -Educate your family and friends about sun protection

15 Prevent Skin Cancer Stay in the shade.

16 A: Avoid Unprotected UV exposure especially at peak hours > UV Index > UV intensity peaks on Summer Solstice > 80% of rays penetrate the clouds

17

18

19 Prevent Skin Cancer (cont) Avoid peak sun hours: 10 AM 4 PM.

20 Prevent Skin Cancer (cont) Wear protective clothing.

21 W: Wear Sun protective clothing and sunglasses, and seek shade > Wear long sleeve shirts > A hat with a 3 inch brim > Sunglasses > Seek Shade

22

23 Regular summer clothing is not an optimal alternative > Regular clothing shows much skin > Most regular summer clothing fabric protects less that SPF 30 > Clothing should maximize skin coverage

24 Sun Protective Clothing:

25 Swimwear Trends: Sun Protective Clothing is an Old Idea > 1920s Clothing coverage has halved from 1920s to 1995, but vacation time at sunny resorts increased 30 fold.

26 Swimwear Trends > 1950s The increase in melanoma was associated with increased sun exposure years earlier

27 Swimwear Trends: Modern Times brought less clothing, more sun, more skin cancer > 2000s

28 Prevent Melanoma (cont) Wear protective sunglasses.

29

30 Prevent Skin Cancer (cont) Use sunscreen on unprotected areas.

31

32 A: Apply broad spectrum sunscreen > Apply a SPF 30+ to all unprotected skin > Use 1 ounce per application for adults to achieve total body protection > Apply 20 minutes prior to exposure > Reapply every 2 hours or after swimming or perspiring

33 What about sunscreen for protection > The literature reports usage is typically 1/10 to ½ the recommended amount > One adult at the beach or pool for 6 hours needs to completely use a 4 oz bottle of sunscreen > Under application leads to sunburn

34

35

36 Prevent Melanoma (cont) Check your skin.

37 R: Routinely check your whole body for changes > Anyone can get skin cancer anywhere > Report suspicious changes to a healthcare practitioner

38 I Know my ABCs! Do You?

39 Self-exam: What to Look For ABCDE method > A for Asymmetry > B for Border > C for Color > D for Diameter > E for Evolution

40 The ABCDEs of Melanoma: Asymmetry Symmetrical: Asymmetrical:

41 The ABCDEs of Melanoma: Border Regular: Irregular:

42 The ABCDEs of Melanoma: Color Consistent: Variable:

43 The ABCDEs of Melanoma: Diameter Normal: Large:

44 The ABCDEs of Melanoma: Evolution

45 Diagnosing Skin Cancers & Melanoma > Biopsy Standard of care Partial or complete removal of mole or lesion Determines depth of lesion Best for melanomas <1.5 cm in size

46 Staging Melanoma > Classifies severity of disease Thickness and depth of primary mole or lesion Ulceration (breaking through the top layer of skin) Spread to other sites (metastasis) > Procedures Biopsy SLN mapping Other tests

47 The Stages of Melanoma Stage IA Stage IB Stage IIA Stage IIB Later Stages

48 The Stages of Melanoma (cont) Stage IIIA Stage IIIB Stage IIIC Stage IV

49 Melanoma/Skin Cancer Management > Primary care physician > Dermatologist > Surgeon > Medical oncologist

50 Points to Remember > It is better to prevent skin cancer and melanoma than to have to treat it Minimize sun exposure: Shade, cover, sunscreen > Perform regular self-exams exams to catch any suspicious moles or other lesions as early as possible > If you find something that you suspect is a skin cancer, see a health care provider as soon as possible

51 Your Skin is Precious, please take care of it!

52 Other Conditions Treated in > Acne > Warts > Moles > Skin rashes > Eczema > Psoriasis > Skin Growths > Leg Veins > Unwanted Hair Growth Dermatology Clinic: > Rosacea > Fungal Infections of the Skin and Nails > Allergic Reactions on the Skin > Any condition of the hair, skin and nails

53 Thank You! medicine.creighton.edu Dermatology: Skin cancer screenings

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