The skin is the largest organ of the body. It is our body’s barrier from UV light, pathogens, and injuries (chemical or mechanical).
Three Layers of the Skin
- Epidermis: the outermost layer of the skin
- Dermis: the middle layer of the skin—you can find here the sweat glands, hair follicles, sensory neurons, muscles, and blood vessels
- Hypodermis: the innermost layer of the skin—also called subcutaneous fascia, it contains lobules of adipose tissues, hair follicles, blood vessels, and sensory neurons
Layers of the Epidermis
- Stratum basale
- Stratum spinosum
- Stratum granulosum
- Stratum lucidum
- Stratum corneum
Cells in the Epidermis
- Keratinocytes: can be found in the basal layer; these cells handle the production of keratin and secreting lipids which form a water barrier, it also regulates calcium absorption
- Melanocytes: they are found between stratum basale; this cell produces melanin
- Langerhans’ cells: they are dendritic cells; they are the first line of defense and play a great role in antigen presentation
- Merkel’s cells: the main function of this cell is sensory; it is seen at the fingertips.; you can also find this in your soles, palms of the hand, oral and genital mucosa
Layers of the Dermis
- Papillary layer: the thinner layer that contacts the epidermis; this is the upper layer composed of loose connective tissue
- Reticular layer: this is the thicker and inner layer; it is composed of dense connective tissues or bundles of collagen fibers
Skin Cancer
Skin cancer is the abnormal growth of cells in your skin. This often develops in the parts of your skin most exposed to the sun. The areas in which it could develop are the face, lips, scalp, ears, neck, chest, hands and arms, and legs on women.
This type of cancer begins in the epidermis. The cells that are affected are basal cells, squamous cells, and melanocytes.
Skin Cancer Types
- Basal cell carcinoma: also known as nonmelanoma skin cancer
- Squamous cell carcinoma: is also called nonmelanoma skin cancer
- Melanoma: less common cancer type but can invade tissues that are nearby and can spread to other parts of the body
In this review, we will look at basal cell carcinoma, squamous cell carcinoma, melanoma, and actinic keratosis. Actinic keratosis is a skin condition that can progress to squamous cell carcinoma.
Signs of Squamous Cell Carcinoma and Basal Cell Carcinoma
- The skin looks raised or pearly
- The area around the skin looks firm like a scar; the color could be yellow, waxy, or white
- You can see the skin looked raised, reddish-brown, scaly, bleeding, or crusty
- A sore that doesn’t heal
Signs of Actinic Keratosis
- Scaly patch on the skin that appears flat or raised
- You could see rough, pink, red, or brown skin
- The lips could crack or peel that can’t be helped using petroleum jelly or lip balm
The ABCDE of Melanoma
- A-symmetry: Uneven mole or birthmark
- B-order: Ragged, irregular, blurred edges
- C-olor: Varying shades of black or brown, sometimes may have pink, white, red, or blue patches
- D-iameter: The size of the spot is more than 6mm across, though some melanomas can be smaller than this
- E-volving: Changes in size, shape, and color of the mole
Risk Factors
- Prolonged exposure to the sun (natural or artificial)
- Genetics
- Fair skin that develops freckles under sun exposure, blonde or red hair, and green or blue eyes
- Weakened immune system
- History of frequent sunburns
- Treatment with radiation in the past
- Old age
Tests and Procedures
- Physical Exam
- Skin Exam
- Skin Biopsy
- Diagnostic Tests
- CT Scan
- Chest Xray
- PET scan
- Ultrasound Exam
- Eye exam
- Lymph node biopsy
Treatment
- Surgery
- Radiation Surgery
- Chemotherapy
- Photodynamic Therapy: this treatment is a combination of light and drugs; this combination kills cancer cells
- Immunotherapy: the patient’s immune system is boosted in treating this type of cancer; medicines used are cemiplimab and pembrolizumab as a treatment for squamous cell carcinoma
- Chemical peel: a chemical solution is put on the skin to dissolve the skin cell’s uppermost layer
- Other drug therapy: Topical drugs such as diclofenac and ingenol are used; also used for the treatment of actinic keratosis
Nursing Interventions
To reduce the risk of infection due to the invasive procedures done to the skin, the nurse has to:
- Assess patient’s skin for signs of infection (pus or redness)
- Emphasize personal hygiene
- Check temperature
- Promote proper handwashing techniques to fellow staff and visitors
- Track CBC, WBC, and platelet as ordered by the physician
- Administer medicines such as antibiotics as prescribed by the physician
- Check temperature
