Skin Cancer

Microstaging

The assessment of the level of invasion of a malignant melanoma and the maximum tumor thickness.

A client who has different types of skin lesions inquires if any of them indicate a risk for developing skin cancer. The nurse explains that which is a risk factor for skin cancer? A. Keloids B. Nevi C. Skin tags D. Angiomas

B Nevi are the skin lesions that should be monitored for changes as they can become malignant.

Nevi

Moles.

A client presents to the urgent care with an itchy, bulky, shiny tumor on his scalp that is pink in color and ulcerated in the center. The tumor started out appearing like a pimple about 6 months ago but has since doubled in size. Based on the client's history and the appearance of the tumor, which malignant skin lesion would the nurse suspect this client might have? A. Nodular basal-cell carcinoma B. Actinic keratosis C. Malignant melanoma D. Squamous-cell cancer

A The nurse would suspect a nodular basal-cell cancer given that the lesion is bulky, shiny, pink, and started out as a papular lesion which has grown rapidly in the past 6 months.

Morpheaform basal cell carcinoma

A type of skin cancer. Are more difficult to detect. These tumors are usually pale, firm, flat growths that can blend into the normal skin around them. Many look just like a scar.

Pigmented basal cell carcinoma

A type of skin cancer. Is a clinical and histological variant of basal cell carcinoma that exhibits increased pigmentation.

Keratotic basal cell carcinoma

A type of skin cancer. Is an uncommon type of BCC that appear as numerous small papules on the skin.

Superficial basal cell carcinoma

A type of skin cancer. Is one of the most common types of BCC that is usually present as an erythematous (red) patch on the skin of the chest and back.

Basal cell cancer

An epithelial tumor believed to originate either from the basal layer of the epidermis or from cells in the surrounding dermal structures.

The nurse is caring for a client admitted to an inpatient unit with fever and leukocytosis. During the initial examination, the nurse finds a suspicious-looking skin lesion possible indicating malignancy. Which skin lesion is a form of skin cancer? (Select all that apply) A. Psoriasis B. Malignant melanoma C. Squamous-cell carcinoma D. Basal-cell carcinoma E. Actinic keratosis

B,C,D Basel-cell carcinoma is an epithelial cancerous tumor originating from the basal layer of the epidermis or from cells in the surrounding dermal structures. Squamous-cell carcinoma is a malignant tumor of the squamous epithelium of the skin or mucous membranes. Malignant melanoma is a cancerous skin lesion that arises from the melanocytes, or the cells located at or near the basal layer of the skin.

Which situation reflects that the client diagnosed with skin cancer has met goals during the evaluation phase of the nursing process? (Select all that apply) A. The client reports that postoperative pain is not managed B. The client reports an increase in anxiety C. The client describes the need to examine skin lesions for changes D. The client verbalizes an awareness of avoiding use of tanning equipment E. The client remains free from signs and symptoms of infection of the lesion

C,D,E An indicator that a client has successfully met a care/intervention goal is the client's ability to identify the need to routinely examine skin lesions for changes and verbalize an awareness of needing to avoid tanning equipment. In addition, remaining free from signs and symptoms of infection indicates the client's efforts in proper skin care.

Squamous cell cancer

Is an uncontrolled growth of abnormal cells arising in the squamous cells, which compose most of the skin's upper layers (the epidermis). SCCs often look like scaly red patches, open sores, elevated growths with a central depression, or warts; they may crust or bleed.

The ABCD rule for recognizing lesions suspicious for skin cancer stands for what? A. Asymmetry, border irregularity, color variation or dark black, and diameter >6mm B. Asymmetry, boarder irregularity, color variation or dark black, and diameter <5mm C. Asymmetry, biopsy, color variation or dark black, and diameter > 6mm D. Asymmetry, biopsy, cancer, diameter <6mm

A ABCD is an acronym for asymmetry; border irregularity; color variation within the lesion or dark black color; and diameter >6mm

The nurse is instructing a group of elders about non-melanoma skin cancer. I client asks what attributes make a person more prone to develop that type of skin cancer. The nurse responds with which of the following? A. Blond hair, freckles, fair skin B. Alopecia, thin hair, itching C. Dark hair, dark skin, dry skin D. Tanned skin, dark hair, edema

A People with fair skin are more likely to develop non-melanoma cancer and should have a yearly total body check for lesions.

A client of Scandinavian descent is in the clinic for an annual physical examination. Which nursing assessment is most significant to the development of malignant melanomas? A. A change in the size of a nevus B. A dietary intake of high-calorie foods C. Sexual contact with a person who has herpes infection D. Inadequate knowledge regarding infection prevention

A The amount of melanin pigment in the skin protects against the development of non-melanoma skin cancer. People who have fair complexions and tend to freckle or sunburn easily, such as people of Irish, Scandinavian, or English ancestry, have a low amount of melanin, thus lowering their protection against the damage produced by the suns' UV rays.

The nurse is caring for a client with a history of malignant melanoma. While performing the admission assessment, the nurse reviews ongoing self-care with the client. Which assessment parameter is a priority during the initial physical examination? A. Detailed skin assessment B. Detailed foot examination C. Mental health examination D. Dental examination

A The client with a history of malignant melanoma should perform regular self-assessment of the skin and report any suspicious lesions or findings. Regular skin examinations by a healthcare provider should also be encouraged according to the suggested follow-up schedule to evaluate for recurrence. The nurse should complete a detailed skin assessment to assess for suspicious lesions or findings.

The nurse is performing a focused assessment on a client a week after a skin biopsy was performed. The nurse concludes that the client has met the outcome goals as demonstrated by which of the following? A. Client verbalizes the absence of pain B. Incision is slightly red with edema C. Client is uncommunicative D. Client is anxious about further episodes of cancer

A The goals following biopsy are that there will be no pain, the biopsy site is healed without signs of infection, and the client's anxiety regarding cancer is reduced.

Melanomas

A type of malignant skin cancer. The most serious type of skin cancer.

Nodular basal cell carcinoma

A type of skin cancer. Is the most common type of BCC that is present as nodules on the skin, usually in the head and neck area.

A client is returning to the oncology clinic after a skin biopsy on an arm lesion that revealed melanoma. Which additional diagnostic tests would be done to evaluate this client for metastasis? (Select all that apply) A. Bone scan B. CT scan of the liver C. Radiation therapy D. Chest x-ray E. Liver function tests

A,B,D,E The client with a positive biopsy for melanoma would need further diagnostic tests to rule out metastasis and to perform staging of the malignancy. These would include a CT of the brain and liver, liver function tests, an initial chest x-ray, and a bone scan.

The nurse is caring for a client admitted to the oncology floor with malignant melanoma. What are the types of malignant melanomas? (Select all that apply) A. Congenital nevi B. Lentigo maligna C. Solar keratosis D. Hyperkeratosis E. Dysplastic nevi

A,B,E Congenital nevi, Lentigo maligna, Dysplastic nevi

A client seen in the dermatology clinic was diagnosed with actinic keratosis by the healthcare provider and sent for specialty follow-up. Which treatment option is for actinic keratosis? (Select all that apply) A. Cryotherapy B. Phototherapy C. Topical creams D. Curettage E. Chemical peeling

A,C,D,E Cryotherapy is the most common treatment for actinic keratosis. Curettage is also used to scrape off damaged cells; it may be followed by electrosurgery, in which a pencil-shaped instrument is used to cut and destroy the affected tissue with an electric current. Topical medications used to treat actinic keratosis include creams that destroy cells by blocking essential cellular functions. Chemical peeling involves applying a chemical solution that causes the skin to blister and peel, allowing new skin to form.

The nurse is caring for a client recovering from the excision of an 8-mm malignant melanoma on the face. Which nursing diagnoses are most appropriate, considering the client's condition? (Select all that apply) A. Alterations in skin integrity B. Decreased anxiety C. Potential for increased postoperative pain D. Improved self-acceptance E. Increased risk of skin infection

A,C,E The postoperative client may be at risk of increased pain, increased risk of infection, and impaired skin integrity following the excision of a malignant melanoma.

The nurse is caring for a client with malignant melanoma on her leg who was recently admitted to the oncology floor for biopsy. The client says that she has heard about certain skin lesions that are precursors to melanomas, and she asks the nurse to tell her about how they typically look so that she can make sure other family members know to check themselves for moles. The nurse would tell her about which of the following skin lesions that are precursors to melanoma? (Select all that apply) A. Dysplastic nevi B. Solar keratosis C. Actinic keratosis D. Congenital nevi E. Lentigo maligna

A,D,E Congenital nevi are present at birth. Their size ranges form small to very large, and they are typically brown or black in color. They have an irregular surface and fairly regular border. Dysplastic nevi are precursors to melanoma and typically appear normal in childhood but become dysplastic after puberty. Their pigmentation is irregular, with mixtures of tan, brown, black, red, and pink. Lentigo maligna is a tan or black patch on the skin that looks like a freckle, grows slowly, and over time becomes mottled, dark, thick, and nodular; it is usually found on one side of the face in elderly people.

Mrs. Sorkilmo is a 62-year-old woman who has been diagnosed with a pigmented basal-cell carcinoma following a skin biopsy. Mrs. Sorkilmo has already had an excision of the lesion. Which additional therapies could also be expected to be recommended by the physician? (Select all that apply) A. Immunotherapy B. Laser surgery C. Topical creams or gels D. Radiation therapy E. Chemotherapy

A,D,E Immunotherapy, radiation therapy, and chemotherapy are additional therapies that may be recommended by the physician for a nonmelanoma type of skin cancer.

While teaching a skin cancer prevention class at the local community center, which instruction should be included in the presentation? (Select all that apply) A. Perform skin self-exams B. Apply sunscreen to newborns C. Use sunscreen with SPF of 10 D. Refrain from using tanning equipment E. Wear broad-brimmed hats and sunglasses

A,D,E Tanning machines increase an individual's risk of skin cancer. Daily application of SPF 15 or higher is recommended. Skin self-exams are encouraged to detect changes in skin lesions. Newborns should not be exposed to direct sunlight; infants >6 months should have sunscreen applied. Broad-brimmed hats and sunglasses block UV rays.

Actinic keratosis

An epidermal skin lesion directly related to chronic sun exposure and photodamage.

The nurse is caring for a client who was diagnosed with actinic keratosis. Which topic will the nurse include in the discharge teaching for this client? (Select all that apply) A. Avoiding indomethacin, lithium, and beta-adrenergic blocking agents B. Wearing long sleeves if outdoors during peak sun hours C. Avoiding sun exposure D. Seeking medical attention for any shiny or scaly skin lesions E. Using sunscreen with at least 15 SPF

B,C,D,E Actinic keratosis is directly related to chronic sun exposure and photodamage, and to psoriasis. The UV radiation exposure induces cellular DNA mutation in the skin. The absence of further UV light exposure may result in resolution through repair mechanisms. Additional UV light exposure may induce further DNA mutations, resulting in squamous-cell cancer. The client should be taught to wear long sleeves, long pants, and a wide-brimmed hat if outdoors during sunlight hours. Using sunscreen with an SPF of at least 15 reduces the rate of the disorder.

The nurse has selected a nursing diagnosis of anxiety for a client diagnosed with basal cell carcinoma of the skin based on which behavior by the client? (Select all that apply) A. Client requests information about prevention B. Client is agitated C. Client states that it probably is not cancer D. Client asks about treatment E. Client is angry

B,C,E Signs of anxiety can include denial, agitation, and anger.

The nurse is conducting an assessment of a client diagnosed with melanoma. Which item will the nurse include in the client's health history? A. Inspection of skin color B. Measurement of skin lesions C. Family history of skin cancer D. Palpation of skin texture

C During the health history portion of the nursing assessment, the nurse would assess for a family history of skin cancer.

The nurse is instructing the family of a child regarding the care of a biopsy site performed to diagnose skin cancer. Which statement by the family indicates a need for further instruction? A. "I will call the physician if there is any drainage from the wound." B. "I will use the antibiotic ointment as ordered." C. "I will remove the dressing when I get home and cleanse the site with tap water." D. "I will bring the child back in 7 days to move the sutures."

C Following a skin biopsy, the nurse instructs the family to keep the dressing dry for 8 hours and then remove the dressing and cleanse the area with tap water daily to remove dry blood or crusts.

Which nursing intervention would address the issue of hopelessness in relation to the diagnosis and treatment of melanoma? A. Decreasing sensory stimuli B. Monitoring for infection C. Encouraging participation in self-care D. Encouraging adequate intake of protein and calories

C To address hopelessness, it is important to promote normalcy, so encouraging participation in self-care, a normal activity, addresses this aspect of hopelessness.

A nodular basal-cell carcinoma, one type of basal-cell cancer, is characterized by which clinical manifestation? A. It is an erythematous plaque B. It concentrates melanin pigment C. It does not ulcerate and crust D. It is papular in the early stages

D In their early stages, nodular basal-cell cancers are papular, much like a small pimple. They may bleed easily from even a mild injury, but they do not ulcerate.

A client returns to the clinic one week after a skin biopsy of a suspicious lesion. The biopsy report indicates that the lesion is melanoma and further surgery is indicated. The nurse explains that this type of lesion has which characteristic? A. Encapsulated B. Rarely metastatic C. Characterized by invasion of local tissues D. Highly metastatic

D Melanomas are pigmented lesions originating in the melanin-producing cells of the epidermis. The skin cancer is highly metastatic and a person's survival depends on early detection and treatment.

The nurse is caring for a client admitted for malignant melanoma on his trunk. What is the treatment of choice for malignant melanoma? A. Immunotherapy B. Cryosurgery C. Curettage D. Surgical excision

D Surgical excision of the lesion is the treatment of choice for clients with malignant melanoma. These require wide excisions that include the full thickness of the skin and the subcutaneous tissue.

The nurse is discharging the client after a biopsy for possible skin cancer. What is the nurse's initiative to prevent infection? A. Instruct the client to keep the wound covered for 3 days B. Make the first dressing change to teach dressing change techniques C. Instruct the client to clean the wound with hydrogen peroxide D. Request that the client perform a return demonstration of wound care

D The best way to ensure that the client understands teaching in this case is to have the client perform a return demonstration of care of the wound.