Skin cancer prevention and detection by nurses: attitudes, perceptions, and barriers

BACKGROUND

To examine attitudes and perceptions of nurses with respect to skin cancer prevention and detection; to identify barriers to skin cancer prevention and detection by nurses.

METHODS

Descriptive survey of 457 nurses from the Texas State Board of Nurse Examiners in 1997.

RESULTS

Eighty-nine percent of the nurses reported that skin cancer was a serious problem, and 97% believed that many people were at risk. More than 89% stated that skin cancer prevention/detection would benefit patients, and 94% believed that such skills would benefit nurses. Eighty-four percent reported that it was in their scope of practice to teach skin cancer prevention to patients, and 61% stated that it was in their scope of practice to detect skin cancer in patients. Barriers to skin cancer prevention and detection included lack of national guidelines (69%), low priority among doctors (63%), and the belief that patients should take full responsibility for prevention (50%). Barriers to continuing education for skin cancer screening included lack of money (43%), not knowing how to obtain education (41%), time away from work (36%), and time away from home (26%).

CONCLUSIONS

These findings may suggest that nurses can play a role in skin cancer prevention and detection.

Managing patients with fungating malignant wounds

Fungating malignant wounds are caused by the infiltration of the skin and its supporting blood and lymph vessels by a local tumour, or result from metastatic spread from a primary tumour. Without treatment, the fungation has the potential to extend and cause massive damage to the wound site, through a combination of proliferative growth, loss of vascularity and ulceration (Grocott, 1999).

Nursing a patient with a malodorous fungating non-healing wound

Mr Lunn, who is 59 years old, was admitted to hospital with an acute bowel obstruction secondary to an adenocarcinoma of the descending colon. During a laparotomy and colocolonic bypass Mr Lunn was found to have large plaques of cancer in the mesentery, omentum and liver, and a diagnosis of carcinomatosis was made. He declined treatment with chemotherapy. After discharge from hospital, Mr Lunn was referred to the district nursing team for assessment and nursing care of his surgical wound.

Psychological adjustment to the melanoma experience

OBJECTIVES

To provide a review of the literature on the psychological adjustment to malignant melanoma.

DATA SOURCES

Research reports and review articles.

CONCLUSIONS

Three prominent themes evolved from the literature: (1) delineation of issues concerning long-term survivorship and quality of life following a diagnosis of melanoma; (2) coping with metastatic and end-stage melanoma; and (3) identification of the possible link between immunomodulation and the evolution of melanoma.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses must individualize their support and counsel according to the potential trajectory of the patient's melanoma experience. Nurses need to identify an individual's risk for psychological distress and help them enhance coping skills.

The hidden side of nursing: why caring for patients with malignant malodorous wounds is so difficult

OBJECTIVE

This cross-sectional qualitative study used semi-structured telephone interviews with palliative care nurses working in urban and rural settings in Australia to explore their experiences of dealing with patients with malignant, often malodorous, wounds.

METHOD

This paper was the second phase of a research project examining the care of patients with malignant wounds. Of 71 palliative care nurses in New South Wales invited to participate, 26 took part, 17 of them working in community positions. The data from the telephone interviews were transcribed and analysed, using content analysis, and coded for themes relating to the nurses' experiences of caring for this patient group.

RESULTS

Nurses working in this setting strove to do the best for patients and their families under circumstances that are emotionally and physically difficult. Some of them suffered personal distress as a consequence. Patient isolation and altered body image are significant challenges for these nurses.

CONCLUSION

The nature of the work these nurses do, in particular the fact that they are dealing with cancers, tends to push them into literal and practical silence. But the researchers question whether this is always the best option. They ask if hiding feelings could be bad for nurses and patients alike. In qualitative research it is not appropriate to generalize the results, although lessons can be learnt from the experience of this group.

The management of high-risk melanoma: staging, treatment, and nursing issues

The incidence of malignant melanoma continues to increase. Treatment of high-risk disease requires a rigorous course of therapy. Nurses who care for these patients must understand the disease and its therapy to adequately prepare patients for treatment. The diagnosis, staging, treatment, and symptom management for high-risk melanoma are reviewed.

Cutaneous metastatic breast cancer

Breast cancer is the most commonly diagnosed cancer in women and the second leading cause of cancer deaths among women in the United States. Many women diagnosed with breast cancer will achieve a cure with surgery followed by adjuvant chemotherapy, hormonal therapy, or radiation therapy; however, some breast cancer survivors will develop locally recurrent disease. Skin metastases are one of the most distressing presentations of locally recurrent breast cancer. The purpose of this article is to increase oncology nurses' understanding of the pathophysiology of cutaneous metastases, facilitate recognition of the various presentations of cutaneous metastatic breast cancer, discuss management of both the underlying disease process and skin lesions, and identify issues of psychosocial support for patients and families throughout the continuum of illness.

Malignant cutaneous wounds

Very little literature is available about malignant cutaneous fungating wounds, and most of the research has been conducted in England. Although only a small number of patients with cancer develop the traumatic and devastating complication of a malignant cutaneous wound, it can be a very distressing occurrence. These patients usually are in the last few months of their lives, and the presence of a wound may be a constant reminder of their disease (Naylor, 2002). In addition, patients may need to cope with bleeding, exudates, odor, or infection. Caring for these patients may be challenging but it can be rewarding if the patients are able to maintain or improve their quality of life.

Malignant fungating wounds: assessment and management

Approximately 5-10% of patients with metastatic cancer will develop a fungating wound. The disfiguring or unpleasant nature of these wounds can lead to complex psychosocial problems in patients, which mean that many will seek medical assistance only when the wound is advanced. Curative treatment is often not an option, although a range of palliative treatments may be tried. When the tumour does not respond to these treatments the patient will be left with a chronic complex wound with local wound management as the only option. It is at this time that the community nurse usually becomes involved with the patient. This article discusses the assessment of patients with fungating wounds in the community, taking into consideration the immense psychological distress that they can cause. It highlights factors that need to be taken into consideration when assessing these complex wounds. Many of them are heavily exuding, malodorous and bleed easily. Strategies that focus on managing these symptoms are explored and recommendations for clinical practice are made.

Patients' perceptions of fatigue in response to biochemotherapy for metastatic melanoma: a preliminary study

PURPOSE/OBJECTIVES

To explore patients' perceptions of fatigue in response to biochemotherapy treatment for metastatic melanoma.

DESIGN

A descriptive-correlational, cross-sectional study.

SETTING

A cancer center in the midwestern United States.

SAMPLE

12 adult patients between the ages of 28-70 who received at least one cycle of biochemotherapy treatment for metastatic melanoma (stages III and IV) from the inpatient or outpatient services of a midwestern cancer center.

METHODS

A demographic data sheet and the Revised Piper Fatigue Scale (PFS) were used to collect data at a single point in time after patients received at least one cycle of biochemotherapy.

FINDINGS

The majority of patients who received biochemotherapy reported severe or moderate fatigue. Female patients' total fatigue scores were higher than those of male patients. Fatigue duration varied from hours to months, with a maximum duration of 12 months after biochemotherapy treatment. All of the patients reported that the most direct causes of their fatigue were metastatic melanoma and biochemotherapy treatment.

CONCLUSIONS

Patients who received biochemotherapy treatment for metastatic melanoma reported moderate to severe fatigue. Female patients experienced more intense fatigue than male patients. The findings also supported the multidimensionality of fatigue construct identified in prior fatigue studies. The four dimensions/subscales of fatigue assessed by the Revised PFS were highly correlated to total fatigue scores.

IMPLICATIONS FOR NURSING

Biochemotherapy is a newer treatment modality for metastatic melanoma. Fatigue, one of the severe toxicities from biochemotherapy treatment, necessitates attention from nurses. The findings will assist nurses in teaching patients about fatigue that may be expected during or after biochemotherapy and about self-care strategies to manage fatigue.

A model for nurse-led skin cancer surveillance following renal transplantation

Renal transplant recipients are at high risk for multiple non-melanoma skin cancers (NMSC) that occur at a younger age and behave more aggressively. Consequently, the American Society of Transplantation has recommended that physicians conduct annual screenings for NMSC in this population. Few centres currently offer a dedicated surveillance programme. This article discusses a model for skin cancer surveillance in which a trained nurse works within a validated competency programme to provide annual skin surveillance and education in the renal transplant outpatient clinic.

Dermal electrosurgical shave excision

The dermal electrosurgical shave excision is a fast and inexpensive method of removing epidermal and dermal lesions. The procedure is ideally suited for pedunculated lesions raised above the level of the surrounding skin. It consists of repetitive, unidirectional, horizontal slicing of a cutaneous lesion with a no. 15 blade followed by electrosurgical feathering to smooth out the wound edges. A smoke evacuator is used during electrosurgery to prevent inhalation of heat-disseminated viral particles. The procedure is followed by histologic evaluation of the shaved specimen. Suspicious pigmented lesions should not be shaved because the long-term prognosis of a malignancy may depend on the thickness of the lesion on histologic analysis. Administration of adequate local anesthesia should make this a painless procedure. Basic general surgery skills are required, and formal training in electrosurgery is highly recommended.

Metronidazole gel in managing malodorous fungating wounds

Historically, the incidence of fungating wounds is not well documented. This article looks at the limited up-to-date information on the impact and incidence of fungating wounds in the UK. As fungating wounds generally signal palliative care and rarely heal, the ability to manage their unpleasant symptoms is increasingly important. One of the most distressing symptoms identified by patients is malodour; therefore, this article will review the limited research available on the use of metronidazole preparations to manage malodorous wounds.

Malignant cutaneous wounds: developing education for hospice, oncology and wound care nurses

This article reports the results of an educational project, which included a needs assessment survey and the development of a malignant cutaneous wound educational programme. As there is little information on the differences between the management of malignant cutaneous wounds in the hospice and oncology settings, a survey was undertaken to identify differences encountered by hospice and oncology nurses. This needs assessment survey also included enterostomal/wound-ostomy-continence (ET/WOC) nurses who serve as wound care consultants in oncology and hospice settings. The 12-question survey addressed the frequency of wounds, symptoms, and psychosocial issues encountered. The education programmes was individualized to the setting by determining the differences between the nurses' roles based partially on the survey information. One interesting survey finding was that many of the nurses were using the internet to obtain answers for wound management questions; therefore, a future implication of this project is the need to develop an online malignant cutaneous wound educational programme for nurses.

The palliative management of fungating malignant wounds--generalising from multiple-case study data using a system of reasoning

The project focused on individual experiences, from 45 participants, of living with a fungating wound and the performance of wound dressings in reducing the impact of the wounds on daily living. A case study design was adopted. This posed a key methodological challenge in the form of the contentious epistemological issue, characterised in the literature as the "nomothetic-idiographic dilemma". This issue concerns the nature of knowledge generated from an individual case and its generalisability. A system of reasoning was adopted as the analytic strategy, within a theory-driven evaluation, to abstract general issues from the case study data to construct explanations of symptom control and dressing performance. The latter were generalised beyond the individual cases with the use of theory. This paper focuses on the methodological issues that are inherent in the use of a case study design and the nature of the evidence generated. The system of reasoning is described and illustrated using data from a single participant with advanced uterine cancer and a fungating nodule in the groin.

Alitretinoin (Panretin) gel 0.1%

This review focuses on the use of alitretinoin (Panretin) gel 0.1% therapy as a new topical treatment of cutaneous lesions in patients with AIDS-related Kaposi's sarcoma.

Wound assessment and evaluation

The "Wound Assessment and Evaluation" series includes a short case presentation and differential diagnosis. It is followed by a discussion of the disease or condition and the rationale used in each step of the assessment.

Sézary syndrome: a summary

Sézary syndrome is the leukemic form of primary cutaneous T-cell lymphoma. It is an aggressive disease, with the lowest reported median survival of all cutaneous lymphomas. Patients with Sézary syndrome live with the awareness that they are suffering from an incurable disease. Having to cope daily with extensive skin care regimens, these patients can benefit tremendously from the expertise of dermatology nurses, who can teach them skin selfcare and who are aware of the psychologic impact of this disease. The symptoms, treatments, and emotional distress related to Sézary syndrome are summarized.

CliniSorb activated charcoal dressing for odour control

The potential for charcoal cloth in wound management relates to its well demonstrated ability to adsorb small gas molecules. Charcoal has become increasingly used to contain odour and is especially useful in the management of fungating lesions. This article looks at CliniSorb activated charcoal odour control dressing (distributed by CliniMed) and describes its construction, action and place in wound management.

Supporting patients with fungating breast wounds

Women with fungating wounds experience great mental distress. Breast-care nurses should be sensitive when assessing a patient's needs in order to provide emotional support as well as practical care. Breast-care nurses need to understand the problems associated with altered body image.

Sun exposure and skin cancer prevention in children and adolescents

Skin cancer is the most common form of malignancy today, and its incidence is rapidly increasing worldwide. Sun exposure is believed to be the primary factor behind this trend. Nearly 80% of a person's lifetime sun exposure occurs before age 21. Many skin cancer risk behaviors begin in early childhood; therefore, it is important to target the pediatric population for skin cancer prevention education. Parents, teachers, day care providers, and health care professionals should make sun safety a regular part of their practice. School nurses, in particular, are in a prime setting for educating the greatest number of children about sun safety. Age-appropriate skin cancer prevention education should become a routine part of the health curriculum at all grade levels. Numerous on-line resources are available to assist school nurses in the development of age-appropriate teaching materials and sun exposure policies for schools.

A primary care approach to cutaneous T-cell lymphoma

Approximately 1,000 new cases of cutaneous T-cell lymphoma are definitively diagnosed each year. Mycosis fungoides and Sézary syndrome are the primary lymphomas in this group. Mycosis fungoides can begin in the patch, plaque, or tumor stage or in a combination. Less commonly, its initial presentation is erythrodermic. Because the initial appearance of cutaneous T-cell lymphoma can be subtle and the histopathologic evidence nonspecific, the disease is commonly misdiagnosed as a common dermatologic condition such as chronic eczema. Misdiagnosis can severely affect treatment and prognosis. Clinicians must be able to recognize this disease and know when to include it in the differential diagnosis. This article provides an overview of cutaneous T-cell lymphoma, discusses differential diagnoses, and outlines management considerations.

The community care of a patient with a fungating wound

This case study will discuss the treatment of a malignant fungating wound and the effects that it had on a patient and his family. The article also demonstrates how interprofessional working has benefits for patients, carers and staff.

Surgical treatment of nonmelanoma skin cancer

Nonmelanoma skin cancer is the most common human malignancy. An estimated 2.75 million patients worldwide are diagnosed with skin cancer each year, with more than one million in the United States alone. Treatment for skin cancer includes methods such as cryosurgery, curettage and electrodessication, local excision, and Mohs micrographic surgery. Regardless of the method used, the goal is to provide the patient with the safest, most cost-effective and curative treatment.

A pilot study using nurse education as an intervention to increase skin self-examination for melanoma

BACKGROUND

A pilot study of an intervention using nurse education for skin self-examination (SSE) was conducted in order to determine specific factors that would be important for the design of a larger intervention.

METHODS

Seventy-five subjects completed a pretest, a posttest, a thorough skin examination by a dermatologist, and an educational session by a nurse.

RESULTS

Results showed that the subjects increased the frequency of SSE to a predetermined optimal frequency of once every one to two months. Increases in optimal SSE were associated with increases in knowledge about melanoma (p = 0.006).

CONCLUSIONS

Before intensive campaigns are launched to improve SSE, models incorporating theories of behavioral change should be tested.

The palliative management of fungating malignant wounds

This study focused on the palliative management of fungating malignant wounds and individual experiences of living with such a wound. Dressings were evaluated for the ability to contain these wounds and reduce their impact on daily life. The project extended to collaboration with industry for the development and evaluation of dressings designed to meet patient needs. A longitudinal multiple case study design was adopted. The methodology evolved through three principal phases: quasi-experimental design; emergent collaborative design; and emergent theory-driven evaluation. The radical departure from the initial approach was in response to the methodological problems encountered in a study of individuals with uncontrolled disease. A non-probability sampling plan was adopted, mainly because of the lack of homogeneity in the patient population; 45 participants were included. The length of time patients remained in the study depended on how long they lived. This ranged from a few days to more than two years. A sampling plan was, however, adopted for the data collection. The study had a dual focus: methodology, and the generation of explanations for dressing performance and the management of fungating wounds. The methodological aspect included development of the Teler system as a method of measuring dressing performance against goals of optimal practice in fungating wound management. The second component was a system of reasoning developed as an analytical strategy for abstracting general issues from individual case study data in order to construct explanations. Theory was used to generalize beyond the individual cases. Two forms of explanation for fungating wound management were constructed. These included explanations of individual experiences of living with such a wound and knowledge of the elements of fungating wound management. The impact on the individual was explained in terms of the stigma attached to public disability and a revulsion in society for uncontrolled body fluids. A pivotal relationship emerged between exudate and other wound management problems, including psychosocial aspects. A final critical explanation was developed for the qualification of the theory of moist wound healing to explain the phenomenon of exudate management in fungating and, possibly, other exuding chronic wounds.

The management of fungating wounds

A critical overview of approaches to the management of fungating lesions.

Cutaneous T-cell lymphomas

OBJECTIVES

To describe the current state of the knowledge regarding the pathology, clinical presentation, treatment strategies, and nursing management of patients with cutaneous T-cell lymphoma, specifically, mycosis fungoides and the Sezary syndrome.

DATA SOURCES

Book chapters, review articles, published research studies, proceedings from professional meetings.

CONCLUSIONS

Although mycosis fungoides and the Sezary syndrome are rare, epidemiologic studies suggest an increasing incidence. Advances in cellular biology and immunology result in continuously changing diagnostic and treatment strategies aimed at this illness.

IMPLICATIONS FOR NURSING PRACTICE

Oncology nurses need an understanding of the current state of the knowledge of cutaneous T-cell lymphoma to meet the extensive needs of patients confronted with this chronic, progressively devastating malignancy.

Sentinel lymph node biopsy using lymphoscintigraphy

Cancer surgery has existed as an elective treatment modality for more than 150 years, yet it is relatively unsophisticated in light of the advances seen in other medical disciplines. Using the nuclear medicine technique of lymphoscintigraphy (i.e., mapping lymph nodes using a radioactive isotope), the surgeon can perform a sentinel lymph node biopsy that targets only the lymph nodes that first drain a primary tumor site. This procedure can provide accurate staging information without risking the potential morbidity associated with lymph node dissection. This type of precise biopsy is made possible by using a gamma-detecting instrument coupled with an ultrasensitive probe designed for intraoperative use.