SKIN

Cancer
LAYERS OF SKIN
The SKIN EPIDERMIS
LAYERS OF SKIN
 Differ in size and shape.
 Slightly raised; uneven surface; roughly fair
borders.
 From existing nevi or from a new mole.
 With surrounding erythema, inflammation,
tenderness.
 Periodically ulcerates and bleeds.
 With color variation: blue, red, white
 ASYMMETRY, IRREGULAR BORDER, COLOR
MALIGNANT
VARIATION, DIAMETER >6 MM
melanoma
 Etiology & Risk Factors of
 Unknown
MALIGNANT
 Family history
melanoma
 Men with genes from a family of breast or
ovarian cancer
 Xeroderma pigmentous
 Past history of melanoma
 Moles and PrecuRsor lesions
 Immunosuppressant drugs
 Fair skin, freckling, blond hair, blue eyes
 Too much exposure to UV radiation, tanning
lamps, tanning booths
 Precursor Lesions of
MALIGNANT
Congenital Nevi melanoma
 Lesions are small, others are large enough to
cover the entire body.
 Slightly raised, with irregular surface and a
fairly regular border.
 Color ranges from BROWN to BLACK.
 Precursor Lesions of
MALIGNANT
Dysplastic Nevi melanoma
 aka. Atypical Moles
 Normal nevi during childhood and become
dysplastic after puberty.
 FRIED EGG APPEARANCE; has more than
100 nevi; with one that measures more than
8mm in diameter; at least one with the
characteristic of malignant melanoma.
 Often on the face, trunk, arms, scalp, female
breast, groin, buttocks.
 Precursor Lesions of
MALIGNANT
Lentigo Maligna melanoma
 aka. Hutchinson’s Freckle
 Tan or black patch on the skin that appears
like a freckle.
 Grows slowly, becomes mottled, dark, thick
and nodular.
 Side of the face (areas where there is
excessive sun exposure).
 Arise wherever there is a pigment.
 Unique characteristics.
 Radial Phase
 Growth is parallel
 Flat, border, color pattern
 Long Period
 Vertical Phase
 Penetration of Dermis
 Nodular appearance
SKIN
brain
 Hand , feet scalp
Cancer
 Metastatic (lymph, spleen, liver, lung, bone and
Types of
MALIGNANT
melanoma
Superficial Spreading
MALIGNANT melanoma
 Most common type.
 Arises from pre-existing nevus, with RAISED
EDGES.
 With biphasic growth; radial growth is 1-5
years.
 Lesions are flat and scaly or crusty and are
about 2 cm in diameter.
 Color changes: tan, brown, black  blue,
red, white; MAY ULCERATE AND BLEED
Lentigo Maligna
MALIGNANT melanoma
 Arises from the precursor lesion LENTIGO
MALIGNA.
 Women > men
 Sun exposed areas
 Slow-growing flat nevi (atypical melanocytes grow
parallel with the basal membrane)
 With horizontal growth; radial growth is about 10-
25 years to as large as 10 cm;
 vertical growth (with nodular appearance, freckled
and mottled).
Nodular
MALIGNANT melanoma
 With vertical growth.
 Appears like blood-blisters; ulcerates and
bleeds.
 Arise anywhere and not only on precursor
lesions
 Are raised, dome-shaped, blue-black or red
nodules on areas of the head, neck and trunk
(may or may not be exposed to the sun)
Acral Lentiginous
MALIGNANT melanoma
 aka. Mucocutaneous Melanoma
 Common among blacks.
 Similar to that of lentigo maligna, where the lesion
is more than 3 cm (Radial phase is 2-5 years.):
ENLARGING HYPERPIGMENTED MACULE
 Often affects the palms of the hands, soles of the
feet , mucus membranes and nail beds.
 Men = women
Clinical Manifestations of
MALIGNANT melanoma
border diame
ter
Enlargin
asymmetr evolving
ical color g
elevatin
g
Signs and Symptoms of Nodular
MALIGNANT melanoma
elevat
ed
firm
growi
ng
Diagnosing
MALIGNANT melanoma
 Physical Examination
 Liver Function Test
 Complete Blood Count
 Excisional Biopsy
 CT Scan of the liver
 Chest Radiography
 Bone Scan
 MRI and CT Scan of the brain
 Lymph Node Biopsy
  Excision of the primary lesion and
surgical dissection of the involved
lymph node
 Elective lymph node dissection

Surgery of
MALIGNANT
melanoma
Chemotherapy in
MALIGNANT melanoma
 Decarbazine
 Nitrosureas: Carmustine,
Lomustine
Radiation Therapy in
MALIGNANT melanoma
 Palliative treatment for metastatic
type
 Lymph, SQ, Brain, Bone,
Immunotherapy in
MALIGNANT melanoma
 Interferons
 Intrleukins
 Monoclonal Antibodies
 BCG
 Levamisole
 Tumor Vaccines
 Prevention of
MALIGNANT
Minimize sun exposure.
melanoma
Cover up with wide brimmed hat and
clothing made up of tightly woven
materials when in the sun.
Apply waterproof or water resistant
sunscreen with SPF 15 or higher 30 mins
before sun exposure even on cloudy
days.
Use sunscreen and protective clothing
when near sand, snow, concrete or water.
SELF ASSESSMENT
 20 – 30, q 3 years
 40’s annually
 Precancerous lesions, or at risk
 Monthly assessment

1. Same day each month.

2. After bath, Well lit room

3. Use full length, hand mirror, chair, hair

dryer
4. Examine head and face. Use blow dryer
to inspect scalp.
SELF ASSESSMENT
5. Check hands, including nails. Examine elbows,
arms, underarms.
6. Focus on neck, chest, torso, under breasts.
7. Use hand mirror to inspect back of neck, back,
buttocks.
8. Sitting down check legs, and feet, soles, heel and
nails.
9. Use hand mirror to check genitals
10. Note changes in ABCDE, consistency,
appearance, skin around lesion, sensation
Understanding
BASAL CELLcarcinoma
 Most common among white-skinned population.
 History of long exposure to UV rays.
 Non-metastasizing tumor that extends wide & deep.
 Commonly affects the head & neck.
 Men (55-70 years old)
 *nodular – small-flesh colored , pink, smooth,
translucent nodule that enlarges over time (with
teleangiectatic vessels).
 *superficial – flat, non-palpable, erythematous scaly
plaque (slowly enlarges, with nodular borders and
teleangiectatic vessels)
All about
SQUAMOUS CELL
carcinoma
 Malignant tumor of the epidermis.
 Common among the black populace.
 UV rays exposure
 With red-scaling keratotic, slightly elevated lesion,
with an irregular border, usually with shallow chronic
ulcer; have persistent crusts and raised erythematous
borders
 *intraepidermal – later invades the basement
membrane
 *invasive – from intraepidermal or premalignant
 Monitor signs and symptoms of infection.
 Maintain the cleanliness of the operative site.
 Follow principles of medical and surgical asepsis.
 Hand washing!
 Support the client.
 Allow the client to express feelings and concerns.
 Use active listening, open-ended questions and
reflects the client’s statements.
 Acknowledge and respect the client’s feelings.
 Encourage active participation.
Nursing Care in

SKIN
cancer
 SARCOMA
the ugly truth about
BONE CANCER
understanding
 pathology of
BONE CANCER
 BONE CANCER
etiology & risk factors of

 Unknown
 Past bone trauma
 Asbestos, dioxin, radium
 Enchondromatosis, neurofibromatosis
 Paget’s disease of the bone
 Heredity
 BONE CANCER
etiology & risk factors of

 Previous radiation therapy

 Other cancers
 Vinyl chloride
 Gardner syndrome
 Werner syndrome
 Tuberous sclerosis
 Li-Fraumeni syndrome (retinoblastoma)
BONE CANCER
types of
BONE CANCER
Benign Cartilage-Forming Tumors
SPECIFIC TYPE CHARACTERISTICS
Enchondroma  found in the medullary area of mature cartilage
 usually made up of HYALINE CARTILAGE
 it lacks the characteristics of CHONDROSARCOMA
 affects the hands, feet, humerus, ribs, femur
 20-40 years old
Ecchondroma  affects the cartilage on the surface of the bone
Osteochondroma  most common bone tumor
 grows during the period of skeletal growth
 originates in the epiphyseal plates (cartilage)
 affects single or multiple bones (exotoses)
 affects long bones (proximal tibia & distal femur)
 0-30 years old
BONE CANCER
Benign Bone-Forming Tumors
SPECIFIC TYPE CHARACTERISTICS
Osteoid Osteoma  small bony tumor (less than 1 cm) with demarcated
outline and reactive bone formaton
 surface of long and flat bones
Osteoblastoma  same characteristics but are larger than 1 cm
Osteoclastoma  aka GIANT CELL TUMOR
 multinucleated nature
 aggressive benign tumor with richly vascularized
tissue consisting of plump spindle-shaped cells and
numerous giant cells
BONE CANCER
Malignant Cartilage-Forming Tumors
SPECIFIC TYPE CHARACTERISTICS
Chondrosarcoma  develops in the medullary cavity or periphery
 men
 arises from points of muscle-bone attachments
(knee, shoulder, hips, pelvis)
 from benign bone disease: enchondroma,
ecchondroma, osteochondroma, osteoblastoma,
fibrous dysplasia)
 slow-growing
 PAINLESS
 can destroy the bone and extend into the soft
tissues beyond the bone
 very resistant to RT and chemotherapy
 Dx: prominent irregular flecks and ringlets of
calcifications
BONE CANCER
Malignant Bone-Forming Tumors
SPECIFIC TYPE CHARACTERISTICS
Ewing’s
SPECIFIC
Sarcoma
TYPE men (younger than CHARACTERISTICS
25 years old; usually teen agers)
Osteosarcoma  arises
common from immature
among bone
children marrow
and cells and causes
adolescents
bone
 men, destruction
usually very from
tallwithin
 usually on the
arises from shaftofofmaximal
points long bones or any
growth: portions
distal of
femur,
the
proximal pelvis andproximal
tibia, often metastasizes
humerus to the BONE
MARROW
 pain and swelling on the affected bone
 PAINFUL
skin is warm, shiny, stretched with prominent
superficial
limitationveins
of movements
 tenderness
ROM of the of the involved
adjacent bonebeorrestricted
joint may soft tissue
 with systemic
appearance of effects:
the bone: fever,
firmweight loss, anemia,
white/reddish mass
high ESR becomes
and later and WBCssofter with viscous interior
Fibrosarcoma  formation
lymphadenopathies
of spindle-shpaed tumor cells of
interlacing bundles of collagen
 affects the femur and tibia
 5-80 years old
 BONE CANCER
clinical manifestations of

 Asymptomatic on the early stages

 Painless lump or swelling
 Pain when it is large enough
 Bony mass, may be palable, tender, fixed
 increased body temperature over the mass with
venous distention
 Pain, edema, limited ROM, weight loss
 Fractures
 Neurologic eficits
 Hypercalcemia
 BONE CANCER
diagnosing

 Biopsy
 Radiography/UTZ/MRI/Pet Scan
 Alkaline Phosphatase
 Serum and urine calcium level
 Complete blood count
 Erythrocyte Sedimentation Rate
 Lactate Dehydrogenase
SARCOMA
Immunotherapy in

 Interferons
 Intrleukins
 Monoclonal Antibodies
 BCG
 Tumor Vaccines
SARCOMA
surgery in
 Doxorubicin (Adriamycin)
 Epirubicin (Ellence)
 Liposomal Dosorubicin (Doxil, Dox SL, Evacet,
LipoDox)
 Ifofossfamide (Ifex, Cyfos, Ifosfamidum)
 Gemcitabine (Gemzar)
 Docetaxol (Taxotere)
 Dacarbazine (DTIC-Dome)
 Temozolomide (Methazolastone, Temodar)

SARCOMA
chemotherapy in
 Paclitaxel (Taxol)
 Vincristine (Oncovin, Vincasar)
 Etoposide (VePesid, Toposar)
 Actinomycin (Cosmegen, Lyovac)
 Cyclophosphamide (Cytoxan, Clafen, Neosar)
 Topotecan (Hycamptin)

SARCOMA
chemotherapy in
 Imatinib (Gleevec)
 Trabectedin

 Biphosphonates
 Metastron

SARCOMA
chemotherapy in
SARCOMA
nursing care in

 Acute/Chronic Pain
 Risk for Injury
 Ineffective Coping
 Situational Self-Esteem
KAPOSI’S SARCOMA
defined
 An opportunistic malignancy of the endothelia lining that lines
small blood vessels
 Herpes virus 8
 Affects the skin, oral cavity, GIT, lungs
 One or more macule, papules or violet skin lesion (Leopard
Skin)  enlarge and becomes darker (with raised plaque
tumor)
 Tumor nodules on the trunk, neck, head and tip of the nose
(initially painless)
 GIT: asymptomatic, pain, bleeding, obstruction
 Lungs: dyspnea, cough, hemopysis
 Physical appearance of the lesions and biopsy of at least one of
the lesions