Nurse Role in Skin Cancer Prevention

Nurses routinely teach parents many important health and safety topics for protecting their children.

We teach about the importance of immunizations, proper nutrition and placing newborns on their backs to sleep, and well as an array of safety issues, from using car seats properly to wearing helmets when bicycling.

Yet, one of the health and safety issues nurses have not adequately addressed is protection from the sun.

Nurses need to make patients aware there has been a dramatic increase in skin cancer in recent years, and that it is the only form of cancer that is increasing in the rate of frequency in this country.

According to the National Cancer Institute (NCI), there has been a 600 percent increase in melanoma diagnoses since 1950.

We also need to remind parents that skin cancer is almost completely preventable by using sun-protective behaviors that are common knowledge if not commonly followed, such as:

  • applying sunscreen (SPF 30 minimum) 30 minutes before going outside;
  • wearing protective clothing, hats and sunglasses;
  • avoiding the sun from at peak hours (10 a.m.-4 p.m.);
  • seeking shade; and
  • avoiding tanning salons.

Mollie’s Fund

Perhaps most importantly, nurses need to educate parents about the critical importance of protecting babies from the sun. An excellent place to start is by directing them to the website of the Mollie Biggane Melanoma Foundation, or just Mollie’s Fund, at http://molliesfund.org/.

According to the melanoma awareness and education website, Biggane was a sophomore in college when she discovered a mole on her thigh that would lead to surgeries, chemotherapy and radiation until her death 6 months later at age 20.

As a result, protecting children is a primary focus of Mollie’s Fund, as evidenced by a downloadable pamphlet, “How to Protect Your Baby from Skin Cancer.”

This educational pamphlet is important as research has shown non-melanoma skin cancers develop over time from unprotected sun exposure, while melanoma can be triggered by just a few childhood sun burns.

Several other pamphlets on skin cancer prevention are available on the Mollie’s Fund website: look under the “Downloads” tab atop the homepage, or go there directly by clicking here. http://molliesfund.org/category/downloads/

Positively Preventable

Since skin cancer is almost entirely preventable – 90 percent is caused by exposure to UV rays – but only if a person understands the risk and ways to protect themselves and their families.

In the U.S., approximately one person dies from skin cancer every hour of every day. The most lethal form of skin cancer is melanoma, which metastasizes rapidly, and is so common it is projected to exceed all cancers combined.

Approximately 70 percent of melanomas start in or near a mole, or other dark spot on the skin. A person is at highest risk if he or she burns or freckle easily, has light blue or green eyes, and red or blonde hair.

There are also non-melanoma skin cancers: basal cell and squamous cell carcinomas. Squamous cell carcinoma can also metastasize, whereas basal cell rarely does. Non-melanoma skin cancers are the most common cancers in the U.S., with 3.5 million new cases in 2 million people per year, according to NCI.

That rate has more than doubled since 1992, when there were 1.1 million new cases of melanoma. It does not, however, reflect actual numbers, as reporting of non-melanoma cancers is not mandated.

Skin cancer is the fifth most costly cancer, according to NCI, accounting for 4.5 percent of oncology-related Medicare costs annually.

Shifting National Thought

There needs to be a shift in thinking about sun exposure as a culture before a significant decline can be expected in the rates of skin cancer in the U.S.

Fortunately, nurses are in an excellent position to teach the public about skin cancer prevention and to assist in screenings for cancer.

A national shift in thinking about sun exposure in recent decades was seen in Australia. The country has the highest rate of skin cancers in the world, but following a concerted national education campaign rates have dropped.

As a result of the campaign, children are not allowed outside to play at recess unless they have on a hat, sunscreen, sunglasses and a long-sleeved shirt; while tanning salons are banned.

This change in thinking and behavior is also needed in the U.S., and nurses are ideally suited to transform the public’s attitude toward sun exposure.

If children are taught to wear a hat, sunscreen, and sunglasses when they are young and impressionable, it can become a habit to be used throughout their lives and passed on to the next generation.

A Golden Risk

The dangers of using tanning beds can not be overstated to adolescents and teens either, as melanoma is the most common form of cancer among people ages 15-29, increasing faster in females most probably from teenage girls frequenting tanning salons.

According to one study, there has been a 50 percent increase in occurrence of skin cancers in women since 1980. Other studies have found indoor tanning by persons under age 35 increases their skin risk by 75 percent.

According to American Academy Dermatology, nearly 70 percent of tanning salon patrons are Caucasian girls and women ages 16-29.

While the International Agency for Research of Cancer (IARC) has re-classified tanning beds as carcinogenic to humans. This classification places indoor tanning in the highest cancer risk category afforded by the IARC, which is a division of the World Health Organization.

To the Letter

Nurses are involved in health assessment, promotion, and education for all patients.

When nurses educate parents about sun-protective behaviors, they impact future morbidity and mortality.

Parents and all patients can be taught to remember specific sun-protective behaviors for babies by the following the ABC’s:

A = Away:

Seek shade and avoid sun 10:00 a.m.- 4:00 p.m., when rays are strongest.
B = Block: Use a sunscreen with SPF 30 as a minimum, after age 6 months. Apply 30 minutes before going outdoors; reapply every 2 hours and after swimming or sweating. (Use sunscreen on small areas of infants under 6 months if protective clothing and shade are not available.)
C = Cover Up: Wear long sleeves, a hat and sunglasses (CDC, 2008)..

Skin Self-Exam

Nurses also should encourage all patients to perform a monthly skin self-exam (SSE).

Patients should identify moles, blemishes and birthmarks in order to recognize if changes occur. Taking photos can assist in noting changes in the skin.

CDC advises people pay particular attention to moles, new and old. Changes in color, shape and size of a new mole, changes in the texture of an old mole, or any new sore unhealed after 2 weeks.

Like protecting babies from the sun, danger signs of pigmented lesions (moles) for potential melanoma can be summarized and remembered using the alphabet as follows:

A = A

symmetrical in shape
B = Border irregularity
C = Color, not uniform
D = Diameter, greater than 6mm
E = Evolution, something has changed in the mole (CDC, 2008).

Nobody’s Safe

Nurses should teach patients of all ages about sun protection, and warn them about the dangers of both the sun and indoor tanning.

Nurses also should role-model their natural skin tones to lend credibility to their teaching about skin cancer and sun-protective behaviors.

Finally, patients should be encouraged to examine their skin once a month and have a full-body exam by a healthcare provider annually.

References for this article can be accessed here.

Victoria Siegel is associate professor, Suffolk County Community College, Brentwood, NY.

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