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NURS 287
Rick Nilson

DIAGNOSTIC STUDIES  Biopsy is one of most common diagnostic tests in evaluation of skin lesions. Techniques include punch, incisional, excisional, and shave biopsies.  Other diagnostic procedures include stains and cultures for fungal, bacterial, and viral infections.  Health promotion activities for good skin health include asvoidance of environmental hazards, adequate rest and exercise, and proper hygiene and nutrition.  Sun safety includes sun avoidance, especially during midday hours, protective clothing, and sunscreen.  Actinic keratoses, basal cell carcinoma, squamous cell carcinoma, and malignant melanoma are problems associated with sun exposure.  Actinic keratosis: o Is a premalignant form of squamous cell carcinoma affecting nearly all the older white population. o A typical lesion is an irregularly shaped, flat, slightly erythematous papule with indistinct borders and an overlying hard keratotic scale or horn. o Treatment includes cryosurgery, fluorouracil (5-FU), surgical removal, tretinoin (Retin-A), chemical peeling agents, and dermabrasion.  Skin cancer is the most common malignant condition. Patients should be taught to self- examine their skin monthly.  The cornerstone of self-skin examination is the ABCD rule. Examine skin lesions for Asymmetry, Border irregularity, Color change/variation, and Diameter of 6 mm or more.  Risk factors for skin cancer include fair skin type (blonde or red hair and blue or green eyes), history of chronic sun exposure, family history of skin cancer, and exposure to tar and systemic arsenicals.  Nonmelanoma skin cancers do not develop from melanocytes, as melanoma skin cancers do. Instead, they are a neoplasm of the epidermis. Most common sites are in sun-exposed areas.  Basal cell carcinoma (BCC): o Is a locally invasive malignancy from epidermal basal cells. o Is the most common type of skin cancer and the least deadly. o Tissue biopsy is needed to confirm the diagnosis. o Treatments of electrodessication and curettage, cryosurgery, and excision all have cure rate of more than 90%.  Squamous cell carcinoma (SCC): o Is a malignant neoplasm of keratinizing epidermal cells. o Is less common than BCC. o Can be very aggressive, has the potential to metastasize, and may lead to death if not treated early. o Pipe, cigar, and cigarette smoking area are also risk factors for SCC; therefore SCC is also found on mouth and lips. o Biopsy is performed when a lesion is suspected of being SCC. o Treatment includes electrodesiccation and curettage, excision, radiation therapy, intralesional injection of 5-FU or methotrexate, and Mohs’ surgery.  Malignant melanoma: o Is a tumor arising in melanocytes. o Melanomas can metastasize to any organ. o Is the most deadly skin cancer, and its incidence is increasing faster than that of any other cancer. o Individuals should consult health care provider if moles or lesions show any clinical signs (ABCDs) of melanoma. o Melanoma can also occur in eyes, meninges, and lymph nodes. o Suspicious lesions should be b
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