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Time to Review Skin Cancer Risk
Joanna Shields
Monday May 21, 2007

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A focus on action


Nurses working in all settings must be knowledgeable about skin cancer prevention. Here's what nurses and their patients need to do:

1. Ask patients about skin changes during every visit. Listen for hints that infer a patient may have noticed something odd, but not odd enough to call attention to. Tell patients it is better to find a change is "nothing" than to disregard skin cancer. Any skin change that persists for longer than one month requires a physician's attention.

2. Warn patients about tanning bed dangers. Tanning beds give users a false sense of security because tanners believe they are getting a "safe tan" while they are exposed to dangerous UVA and UVB rays. Moreover, "tanned" skin does not provide protection against the sun. Indoor tanning is especially popular among teenagers.

3. Tell patients that ultraviolet (UV) intensity is affected by planetary and environmental factors. The sun is strongest on June 21 in the northern hemisphere. UV intensity may be increased by planetary revolution and rotation, ozone depletion, altitude, and reflective surfaces. "A person in Massachusetts may be more at risk for sunburn on a 50-degree day in April than on a 100-degree day in August," says Maguire-Eisen. People with light skin and eyes and freckles are most sensitive to UV rays; their skin can burn in 10 minutes on a high-intensity UV day.

4. Warn patients that medications can increase photosensitivity. This especially is pertinent for teens who use acne medications. Commonly prescribed medications such as antibiotics, corticosteroids, NSAIDs, ACE inhibitors, statins, sulfa drugs, calcium channel blockers, SSRIs, and birth control pills also can increase sun sensitivity.

5. Keep patients up-to-date on sun protection products. Two new products are on the market. Helioplex is a combination of the popular sunscreens avobenzone and oxybenzone. The Food and Drug Administration recently approved Anthelios SX for use in sun-protection products. Both products extend the length of time a person can stay in the sun and the amount of photoprotection in the UVA range.

6. Remind patients to be SunAWARE. To do so, they must —

* Avoid unprotected exposure during the peak UV hours between 10 AM and 4 PM

* Wear sun-protective clothing, including a hat with a 3-inch brim and sunglasses, and seek shade. Cataracts are known to develop from overexposure of the eyes to the sun, and, although still rare, there has been an increase in the number of ocular melanomas.

* Apply broad-spectrum sunscreen with SPF 30+ to all unprotected skin and reapply it every two hours. Adults require approximately 1 ounce of sunscreen and children need 1/2 ounce to cover their entire body. Patients need to visualize how much product to apply — mention that 1-2 ounces of sunscreen fills a standard shot glass.

* Routinely check skin for changes and report suspicious changes to a physician. Teach patients how to do complete monthly self-examinations.

* Express the need for sun protection to your family and community.

7. Lastly, be a role model. Adults and children are more likely to heed your sun-related advice if you show you take sun protection seriously.

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Additional sun protection resources


* The Dermatology Nurses Association at www.dnanurse.org or (800) 454-4DNA. Many of their resources are available even if you are not a member. Find out about a skin cancer training session in your area.

* Available for CE credit: Maguire-Eisen, Rothman, Demierre. The ABCs of sun protection for children. Dermatology Nursing. December 2005. Available at: www.dermatologynursing.net/ceonline/2007/article12419434.pdf

* The EPA SunWise Program: www.epa.gov/sunwise

* The American Cancer Society: www.cancer.org

* The National Cancer Institute: www.cancer.gov

* The Skin Cancer Foundation, a good source of photos of lesions, brochures, and posters: www.skincancer.org

* The Children's Melanoma Prevention Foundation: www.melanomaprevention.org

* www.oncolink.com: this website features a nurse notes section.

* Highly recommended book on the subject: Sun Protection for Life, by Mary Mills Barrow, is available at: www.newharbinger.com

* Diagnosing basal cell and squamous cell carcinoma, an article from American Family Physician, features several photographs of nonmelanoma lesions. Available at: www.aafp.org/afp/20041015/1481.pdf
Nurses cannot spend too much time reminding patients about the damaging effects of the sun.

One in five Americans will develop skin cancer in their lifetime, and, since 1930, there has been an 1,800% increase in malignant melanoma.

"The increase is most likely due to a combination of factors," says Karrie Fairbrother, RN, BSN, CDE, DNC, president-elect of the Pitman, N.J.-based Dermatology Nurses Association (DNA). "A major contribution is the change in our perception of beauty. Before 1930, fair skin was considered beautiful. Then clothing styles changed. As we exposed more skin, society began to look upon a glowing tan as the symbol of health and beauty."

In February, Fairbrother attended the American Academy of Dermatology's annual meeting, at which a key presentation featured a melanoma update. She was struck by the fact that despite advances in research and biotechnology, effective options to treat advanced disease remain far from plentiful.

"Speaker Jean-Claude Bystryn, MD, FAAD, emphasized that at this point in time, more patients could be cured if they had early and effective biopsies," Fairbrother says. "This presentation reinforced my belief that nurses serve a vital role not only in advocating for prevention, but in helping patients get diagnosed in time."

Maryellen Maguire-Eisen, RN, MSN, founder and executive director of the Children's Melanoma Prevention Foundation in Hingham, Mass., couldn't agree more. "Nurses have the privilege of defending adults and their children against this deadly epidemic," she says.

Know what to look for

Nurses need to know their ABCDEs so they can help identify skin cancer characteristics:

A = Asymmetry

B = Border irregularity

C = Color variation

D = Increasing diameter

E = Evolution

Don't just give your patients a brochure about skin cancer — take time to discuss the topic with them and solicit their questions.

Today, skin cancer increasingly affects young people. The National Cancer Institute reports melanoma is the most common cancer in caucasian women ages 20-24 and the fourth-most-common cancer in young men of the same age. But skin cancer may go unnoticed in young patients if healthcare providers are not aware of their increased risk. Melanoma increased in children and young adults by 3% yearly between 1973 and 2001. Youngest children are at greatest risk for sun damage.

"An infant doesn't have the natural protection against the sun that an older child may have," says Fairbrother. "Sunburn in an infant can become a medical emergency."

If infants are sensitive to ingredients in sunscreens, they can develop contact dermatitis. Caution parents to keep infants out of the sun; if exposure is necessary, they must make sure their infant is well-covered (including sunglasses) and is kept in the shade.

Joanna Shields is a freelance writer.

More clinical news: Phototherapy is not risk-free

Phototherapy can play an important role in treating certain skin diseases such as psoriasis and mycosis fungoides. Though it is noninvasive and often beneficial, phototherapy also presents risks about which patients need to be aware.

Nurses can play an important role in educating patients on the way phototherapy works, treatment protocols, benefits, and risks. The article, "Photoresponsive Diseases," which appeared in the April 2007 issue of Dermatology Nursing, helps RNs understand the uses of phototherapy in treating various skin diseases and explains treatment methods and options.

The article also describes comprehensive patient education sessions that involve one-on-one time with a nurse. The article can be read in full at www.medscape.com/viewarticle/554933.

More Clinical News was compiled by Jennifer Thew, RN, MSJ, an editorial director for Nursing Spectrum.



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