Hello, welcome back for another YouTube video from SMMP Reviews. My name is Brittany. I'm a nurse practitioner with the SMMP Reviews team, and today we're going to be discussing skin cancer. Skin cancer is the most common type of cancer overall, so it is a topic you are very likely to see on your exams.
We also want to make sure we know what to look for so we can care for patients in future practice. We are going to talk about the risk factors, precursors to skin cancer, and the different types of skin cancers. We are also going to discuss how to proceed when we suspect a patient has skin cancer, as well as the education we can give to help decrease risk. Let's start off with what puts people at higher risk for skin cancer.
Now, while there are factors that can put someone at higher risk, I want to be clear that anyone can get skin cancer. Just because a patient may not fit the risk factor profile, we need to make sure that we consider skin cancer when we see an abnormal lesion on any patient assessment. Characteristics that may put a patient at higher risk include light skin, skin that burns, freckles, or reddens easily, blonde or red hair, a large number of moles.
family history of skin cancer, and increased age. Those who have frequent sun exposure, no matter their physical characteristics, are also at increased risk. Let's talk about prevention. Of course, there are non-modifiable risk factors such as family history, light skin, or increased age, but there are many things patients can do to decrease risk.
Sun exposure is the biggest factor, so it is important to promote sunscreen, and appropriate clothing such as sunglasses, clothes that cover the arms and legs, and hats. Hats are especially helpful for covering sun-exposed areas that are often forgotten like tops of the ears or parts in the hair. Another major risk factor that is easily avoidable is indoor tanning.
Indoor tanning exposes users to high level UV rays which can also lead to skin cancer. Okay, so there are some lesions that can be warning signs or precursors to skin cancer. Take a look at this picture. For example, what is this lesion here? Any ideas?
This is called actinic keratosis. So what is the significance of this lesion? Actinic keratosis is a pre-cancerous lesion that can lead to squamous cell carcinoma.
This is precancerous, so we want to take care of it before it progresses to cancer. So how do we recognize this? Actinic keratosis lesions are typically flaky, scaly, rough. It can be yellow or pink in color or just the color of the patient's skin.
The patient may report itching or burning of the lesion, and if it goes untreated, like we said, it can lead to squamous cell carcinoma. So what do we do if we see this on our patient's skin? We want to get it removed before it progresses to a cancerous lesion. We can refer the patient to a dermatologist for removal.
Typically these lesions are removed via cryotherapy or 5-FU. So we mentioned squamous cell carcinoma, let's dig a little deeper here. Squamous cell carcinoma is a common type of skin cancer.
that often occurs on areas of the body that get exposed to the sun more, like the scalp, shoulders, back, back of the hands, ears, or lips. But it can occur anywhere on the body. So what do these lesions typically look like? There are a few key characteristics to look for.
This cancerous lesion typically has rough edges. It can also be scaly or flaky, but it also may have a nodular appearance or typically has a center ulceration. Okay, let's take a look at this lesion here. What do you think this is? There are a few giveaways here.
Do you see the little blood vessels that run through the lesion? This is called telangiectasia, and what does telangiectasia indicate? So when we see those visible blood vessels running through an abnormal skin lesion, we should definitely be thinking basal cell carcinoma.
One thing to remember about basal cell carcinoma is that it is the most common type of skin cancer, so this is something that you are likely to see in clinic and on your exams. A couple other characteristics to watch for with basal cell carcinoma. It can be waxy and pearly.
It can also be raised. So sometimes it can be a little difficult to keep the characteristics of squamous cell and basal cell carcinoma straight. One thing that helps me is to think of all the B's associated with basal cell carcinoma.
I think of the B in basal cell and also the following words. I think of bump or raised, blood vessels for that telangiectasia, and I also think of the word big because this is the biggest or most common type of skin cancer. That helps me remember what is associated with basal cell versus squamous cell carcinoma.
Okay, before we move on, let's do a practice question. The nurse practitioner is conducting an annual physical exam on a 58-year-old patient. While checking the patient's ears, the nurse practitioner notices a flaky, scaly pink spot on the top of their head. When asked, the patient states they weren't sure how long it's been there, but it is itchy.
What is the likely diagnosis for this lesion? So our options are A, actinic keratosis, B, basal cell carcinoma, C, malignant melanoma, or D, squamous cell carcinoma. So think about what we've covered so far. What do you think is the most likely diagnosis for this lesion? Okay, the answer here is A, actinic keratosis.
Remember that scaly, flaky appearance. The lesion is itchy and it's in a sun-exposed area. This hits all of those characteristics of actinic keratosis. Let's review the other answer options here.
Basal cell carcinoma, remember the Bs, so bump, blood vessels, and those aren't visible here. Malignant melanoma, we are going to talk about more in a moment, but melanoma typically has a dark appearance. asymmetry and is not typically flaky or scaly like actinic keratosis.
Squamous cell carcinoma can be scaly, typically has an ulcerated look or could have a nodular look to it. This is the lesion that the actinic keratosis can progress to if it's not taken care of in time. Okay.
Let's circle back to malignant melanoma. What do we know about this type of skin cancer? So malignant melanoma is the most deadly type of skin cancer. This type of skin cancer can occur anywhere on the skin, including areas that are not as common, such as underneath the fingernails.
It is important while doing physical exams to watch for any strange looking or dark moles. This is an important piece of education as well for patients. What do we tell patients to watch for when they're doing their own skin assessments at home? This is where we use those ABCDEs.
So this ABCDE mnemonic is something that we talk a lot about when we are referring to dermatology, but let's break it down so we make sure that we know what each of these letters mean. First, we have A. What does A stand for? Asymmetry, right?
If the patient has a lesion that is asymmetric, this may be concerning for melanoma. Next is B for borders. If a lesion has irregular or notched borders or has jagged edges, this is another red flag for malignant melanoma. Next is C for color.
Melanomas typically have a darker shade of brown or black. They might have other colors mixed in, such as red or white. Another sign that has to do with color is variation of color on the lesion.
So it's not evenly distributed. Take a look at this picture here. If you notice, one side is darker, one is lighter. So it's not even across the board. Next is D for diameter.
What diameter measurement is considered the cutoff for a suspicious lesion? If a lesion has a diameter of over 6 millimeters, that is suspicious for a melanoma. And lastly, we have E.
What does E stand for? So this can stand for evolving or evolution. Has the lesion changed or does it continue to change? That is another red flag.
So what should we do? What do we do if we have a patient with a questionable lesion that fits this criteria or is suspicious for other types of skin cancer? One thing that really works in our favor for skin cancer in general is that we can take care of the issue by removal if we catch it early.
Remember, with conditions like actinic keratosis, we can use cryotherapy or 5-FU to remove the lesion before it becomes cancerous. We can also refer to dermatology in that situation. If we are concerned about a potential for a cancerous lesion, we should refer the patient to dermatology for biopsy and removal. Okay, you know we always have to apply what we learn.
Just a plug here for anyone about to take your exam. When you study or review a certain topic, please take the time to apply what you learn with some practice questions. I can't stress enough how much this helps really lock in that content. So we're going to do the same thing here with another practice question.
A patient is being seen today for a medication follow-up. As the nurse practitioner interviews the patient, they notice a dark line underneath the patient's fingernail. The patient reports no injury to the finger. What cancerous lesion would be a concern in this situation?
So we've got a actinic keratosis. B, basal cell carcinoma. C, malignant melanoma.
And D, squamous cell carcinoma. Okay, what do you think here? Think about all the different signs and symptoms that we've discussed today.
All right, so the answer here is C, malignant melanoma. Remember the characteristics that we reviewed. Squamous cell carcinoma typically has a scaly or flaky appearance and may be ulcerated. Actinic keratosis is the precancerous lesion. It's dry, flaky, scaly, typically on sun-exposed areas.
Basal cell, remember those Bs. So bump, blood vessels, and it's the big one to remember, right? It's the most common type of skin cancer.
Malignant melanoma, remember those ABCDEs. So asymmetry. borders, color, diameter, and evolving or evolution.
This can also present in those areas that aren't as common, so like with a dark line under the fingernail. This is a less common presentation, but one that we need to watch out for. So bonus question here, when is another time we might see dark lines under a patient's fingernail?
We can see these with... splinter hemorrhages that occur with infective endocarditis. Skin cancer is the most common cancer overall. We are likely to see this in our patients and it is a topic that you are likely to see on your certification exams. The good news is that we can make a big difference in outcomes by educating patients on prevention, performing thorough exams, and knowing what to watch for.
and then taking the proper steps to get the lesions removed. It may seem simple, but these simple things can make a huge difference in these cases. Thank you so much for joining us at the SMNP Reviews YouTube channel. Make sure to subscribe so you can stay up to date on our new videos.
See you next time!