NCLEX Review Guide: Skin Cancer

Basal Cell Carcinoma (BCC)

• Most common type of skin cancer but least likely to metastasize, typically appears as a pearly, waxy nodule or flat, flesh-colored lesion.
• Often develops on sun-exposed areas like face, ears, and neck, with slow growth pattern and rarely spreads to other body parts.

Squamous Cell Carcinoma (SCC)

• Second most common skin cancer with moderate metastatic potential, appears as firm red nodules or flat lesions with scaly, crusted surface.
• More aggressive than BCC and can spread to lymph nodes if left untreated, commonly found on ears, face, lips, and mouth.

Malignant Melanoma

• Most dangerous form of skin cancer with high metastatic potential, can develop from existing moles or appear as new dark spots.
• Requires immediate intervention as it spreads rapidly through lymphatic and blood systems to vital organs.

Primary Risk Factors

• Excessive UV radiation exposure from sun or tanning beds is the leading modifiable risk factor for all skin cancer types.
• Fair skin, light hair, light eyes, and tendency to burn rather than tan significantly increase skin cancer susceptibility.
• Personal or family history of skin cancer, immunosuppression, and age over 50 are additional high-risk factors.

Prevention Strategies

1. Apply broad-spectrum SPF 30+ sunscreen 30 minutes before sun exposure
2. Reapply sunscreen every 2 hours and after swimming or sweating
3. Seek shade during peak UV hours (10 AM - 4 PM)
4. Wear protective clothing, wide-brimmed hats, and UV-blocking sunglasses
5. Avoid tanning beds and artificial UV sources completely
6. Perform monthly self-skin examinations using ABCDE criteria

Assessment Priorities

• Complete skin assessment should be performed in well-lit room with patient completely undressed, examining all body surfaces including scalp, between digits, and genital areas.
• Document location, size, color, texture, and any changes in existing lesions using precise measurements and photographic documentation when possible.

Post-Surgical Nursing Care

• Monitor surgical site for signs of infection including increased redness, warmth, swelling, purulent drainage, or fever above 101°F.
• Teach proper wound care including keeping incision clean and dry, changing dressings as ordered, and avoiding sun exposure to healing tissue.

Self-Assessment Questions

• ☐ Can you identify the ABCDE criteria for melanoma detection?
• ☐ Do you know which type of skin cancer has the highest metastatic potential?
• ☐ Can you list at least 4 sun protection strategies?
• ☐ Do you understand the difference between BCC and SCC appearance?