NCLEX Review Guide: Skin Cancer

Basal Cell Carcinoma (BCC)

• Most common type of skin cancer, arising from basal cells in the epidermis with slow growth and rarely metastasizes
• Appears as pearly, translucent nodules with rolled borders, often with visible blood vessels (telangiectasias)
• Commonly found on sun-exposed areas like face, neck, and ears

Squamous Cell Carcinoma (SCC)

• Second most common skin cancer, more aggressive than BCC with potential for metastasis to lymph nodes
• Presents as rough, scaly patches or raised lesions that may ulcerate and bleed
• Higher risk in immunocompromised patients and those with chronic wounds

Malignant Melanoma

• Most dangerous form of skin cancer with high metastatic potential and poor prognosis if not caught early
• Use ABCDE criteria for assessment: Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving
• Can arise from existing moles or appear as new pigmented lesions

Primary Risk Factors

• UV radiation exposure from sun and tanning beds is the leading cause of all skin cancers
• Fair skin, light eyes, blonde/red hair with inability to tan increases susceptibility
• Personal or family history of skin cancer, multiple moles (>50), or atypical moles
• Immunosuppression from medications or conditions like HIV/AIDS

Surgical Interventions

1. Mohs surgery - Layer-by-layer removal with microscopic examination for complete tumor removal
2. Wide local excision with margins to ensure complete removal
3. Lymph node dissection if metastasis suspected (especially melanoma)

Post-Operative Nursing Care

• Monitor surgical site for signs of infection: increased redness, warmth, purulent drainage, fever
• Teach proper wound care including keeping area clean and dry, applying prescribed ointments
• Educate about activity restrictions and when to remove dressings per surgeon's orders

Common Pitfalls

• Don't assume all skin lesions in elderly patients are "age spots" - always assess thoroughly
• Remember that melanoma can occur in non-sun-exposed areas including palms, soles, and nail beds
• BCC rarely metastasizes but can cause significant local tissue destruction if untreated