98. CCA Study Notes: Skin Cancer, Common Skin Disorders, and Supporting Clients

The Big Picture

Your skin is part of the integumentary system. This system also includes hair, nails, sweat glands, and oil glands. Several diseases and conditions can affect the skin.

Some skin conditions are contagious. Others involve inflammation, allergic reactions, abnormal growths, or cancer. As a CCA, you need to recognize important facts about these conditions while following the care plan and staying within your scope of practice.

Look for Nova Scotia CCA Notes throughout this page for current provincial guidance.

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Course Notes: Key Ideas You Need to Know

The Integumentary System

The integumentary system includes the skin and its appendages. These appendages include:

• hair
• nails
• sweat glands
• oil glands

Skin cancer is a malignant growth involving the integument. Malignant means cancerous and describes a tumour that can invade and destroy other cells or tissues.

A tumour is a new growth of abnormal cells. A tumour can be malignant or benign.

Skin cancer usually develops in the epidermis, so it is easily visible.

The Three Main Types of Skin Cancer

The two most common types are basal cell carcinoma and squamous cell carcinoma. Both are unlikely to spread to other parts of the body.

The most dangerous type discussed here is malignant melanoma. It can be fatal when it is not treated early.

Metastasis means cancer has spread to other parts of the body.

Basal Cell Carcinoma

Basal cell carcinoma is the most common type of skin cancer. It accounts for 90% of all skin cancers.

It usually appears on skin exposed to the sun, such as the neck or shoulders.

Common features include:

• a raised, smooth, pearly bump
• small blood vessels that may be visible in the tumour
• crusting in the centre
• bleeding in the centre

The tumour can look like a sore that does not heal.

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common type of skin cancer.

It begins in the epidermis. It usually appears as a red, scaly, thickened patch on skin exposed to the sun.

If untreated, it can penetrate the tissue underneath the skin. Bleeding and ulceration can occur.

Squamous cell carcinoma is easily treated when found early. In a small percentage of cases, or when it remains untreated, it can metastasize.

Malignant Melanoma

Malignant melanoma is less common than basal cell and squamous cell carcinoma, but it is highly dangerous. It is the eighth most common form of cancer in Canada.

It is caused by excessive ultraviolet, or UV, light exposure from:

• the sun
• tanning beds
• repeated sunburns

Prevention measures include avoiding too much sun exposure and using broad-spectrum sunscreen with an SPF of 15 or greater throughout the year when outdoors.

Signs of Melanoma

Melanomas do not all look the same. Important mole changes and features include:

• more than one colour
• asymmetrical ⓘ shape
• an irregular border or jagged edges
• diameter greater than 6 mm
• itching
• changes in texture
• oozing
• bleeding

Colours can include shades of black, brown, or blue. A melanoma can sometimes contain white, grey, red, or pink.

Key fact: Early detection is critical. A new mole appearing during adulthood should be checked by a physician.

Skin Cancer Treatment

Treatment usually involves removing the lesion and making sure its edges are free of cancer cells.

Methods used to remove a skin cancer lesion can include:

• surgery
• radiation therapy
• cryotherapy, which freezes off the lesion

These are treatment facts to recognize. They are not directions for the CCA to choose or perform treatment.

Staying Within Your Scope of Practice

Some skin treatments may appear simple or familiar. You may even have seen similar treatments performed at home.

Role limit: You cannot perform a treatment that falls outside your scope of practice.

When the care plan gives you a treatment or care direction that is within your role, follow those directions.

Athlete’s Foot

Athlete’s foot is a highly contagious fungal skin infection.

It can cause the foot to:

• peel
• burn
• itch
• become red

It spreads easily through contact in moist areas such as locker rooms and showers. It can also spread when people exchange footwear.

Treatment can involve thoroughly drying the feet, including between the toes. Over-the-counter medication can be used, while severe cases can require prescription medication.

Furuncle or Boil

A furuncle, also called a boil, develops when a hair follicle becomes infected. The infection is usually caused by a type of bacterium called Staphylococcus.

Boils are:

• red
• filled with pus
• painful

Common locations include the:

• back
• underarms
• shoulders
• thighs
• buttocks

A yellow or white point appears in the centre when the boil is ready to drain or discharge pus.

The care plan may direct the use of warm compresses. This process is sometimes called bringing the boil to a head.

You cannot predict when a boil will break.

Safety: Use Standard Practices when giving care around the boil.

Your supervisor will tell you what nursing care is required after the boil drains.

Cysts

A cyst is an abnormal, closed sac that can develop anywhere in the body.

It has a distinct membrane around it and can contain:

• air
• fluid
• semi-solid material

Once a cyst forms, it remains in the tissue unless surgery removes it or medication dissolves the sac.

Dermatitis

Dermatitis means inflammation of the skin caused by direct contact with an irritating or allergy-causing substance.

Two forms discussed here are contact dermatitis and irritant dermatitis.

Contact Dermatitis

Contact dermatitis can occur after exposure to something the person has become allergic to.

Possible allergens include:

• poison ivy
• poison oak
• latex
• cosmetics
• perfumes
• some plants

Symptoms can include:

• itching
• redness
• tenderness
• swelling
• warmth in the exposed area

Irritant Dermatitis

Irritant dermatitis can result from contact with substances such as:

• soaps
• detergents
• chemicals

It usually looks similar to a burn.

CCA action: Follow the care plan and prevent further exposure to the irritant.

Eczema

Eczema is a persistent inflammatory condition of the skin.

Its appearance differs from person to person. In most cases, the skin develops dry, red, extremely itchy patches.

Other cases can include:

• papular lesions, which are solid elevations of the skin
• vesicular lesions, which are elevations of the skin containing fluid

Eczema occurs in children and adults. It often first appears during infancy.

Areas with heavy perspiration ⓘ and the creases of the elbows and knees are often prone to skin breakdown from eczema.

Treatment usually focuses on preventing scratching. Lotions or creams are commonly used to keep the skin as moist as possible.

CCA action: Follow the client’s care plan for any treatment you are directed to carry out.

Eczema is persistent. Research continues into medications that control outbreaks.

Impetigo

Impetigo is a contagious skin disorder caused by Streptococcus or Staphylococcus bacteria.

If a person scratches an infected cut or scratch and then touches another part of the body, the bacteria can spread.

The infected area develops a crust. The crust later drains, which can spread the bacteria further.

Small areas are usually treated with antibiotic ointment. Widespread impetigo may require an oral antibiotic.

Impetigo commonly appears on the hands and faces of children. Contact with an infected person is the most common way it spreads.

When caring for a client with impetigo:

• use Standard Practices when washing around the affected area
• encourage frequent hand hygiene
• wash the client’s linens separately from other people’s linens
• wash the client’s dishes separately from other people’s dishes

These steps help prevent the spread of pathogens.

Psoriasis

Psoriasis is a persistent disorder that can affect the skin and joints. It commonly produces red, scaly plaques, or patches, on the skin.

These patches can appear anywhere on the body.

The scaly patches result from excessive skin production. The skin builds up and becomes inflamed.

As the skin accumulates, it develops a silvery-white appearance.

The cause of psoriasis has not been identified. Two factors that can aggravate it are:

• stress
• excessive alcohol consumption

A client with psoriasis may experience:

• physical discomfort
• itching
• poor self-image related to the skin’s appearance

Many treatments are available, and treatment differs between clients.

CCA action: Follow the client’s care plan when treating affected areas.

Scabies

Scabies is a highly contagious skin infection caused by a mite.

The mite burrows underneath the skin and deposits eggs. This causes an intensely itchy rash.

Scabies spreads through skin-to-skin contact.

Symptoms take approximately 4 to 6 weeks to develop after the first infestation. A client can therefore remain contagious for at least a month before the condition is diagnosed.

This delay allows scabies to spread through a family or facility.

The mites and their burrows are difficult to see. Scabies is often mistaken for intense itching before the red papular eruptions appear.

Treatment usually involves applying a topical product that kills the mites. Some applications are repeated one week later.

If you are carrying out the treatment, follow the manufacturer’s instructions.

After treatment, thorough washing is recommended for all materials that contacted the infected client during the previous 4 days, including bedding and clothing.

Scleroderma

Scleroderma is a rare, progressive ⓘ autoimmune disease. It causes hardening of the skin and connective tissue throughout the body.

There are two main types.

Localized Scleroderma

Localized scleroderma is less severe and usually affects the skin.

Muscles and bones can also be affected. Internal organs are not affected.

Skin lesions can appear as:

• hard, oval, white lesions surrounded by a purple ring
• hard, reddish scales

Generalized Scleroderma

Generalized scleroderma affects the skin and internal organs. It damages the organs.

There is no cure for scleroderma. Treatment usually includes medications that soften the skin and reduce inflammation.

Treatment for affected internal organs varies according to the damage.

Clients may feel self-conscious about changes in their appearance.

CCA action: Treat the client with respect.

Seborrheic Keratosis

Seborrheic keratosis is a noncancerous skin growth commonly found in older people.

The growths can:

• develop alone or in groups
• appear on many areas of the skin
• be dark or multicoloured
• have a grainy surface
• sometimes look smooth and waxy

Seborrheic keratoses can be mistaken for moles or skin cancer.

Shingles

Shingles is a viral infection caused by reactivation of herpes varicella zoster, the same virus that causes chickenpox.

Anyone who has had chickenpox is at risk of developing shingles.

The infection causes a painful rash with raised blisters. The rash can appear anywhere on the body, but it usually appears on one side.

Common locations include:

• the trunk
• buttocks
• face

The blister outbreak lasts about 2 weeks.

Shingles can cause severe pain, itching, or tingling along an affected nerve root. These feelings can occur whether the rash is visible or not.

Pain can continue for:

• weeks
• months
• years

Once a person becomes infected with herpes varicella zoster, the virus remains in the body in a dormant, or inactive, state.

The virus can reactivate as shingles because of:

• stress
• illness
• a weakened immune system

It usually travels along one of the body’s nerve pathways.

If shingles develops on the face and spreads to the eye, it can cause corneal scarring and chronic tearing in that eye.

Shingles can spread through skin contact to people who have not developed immunity to herpes varicella zoster.

Antiviral medications can reduce the length and severity of a shingles infection. A vaccine is also available to prevent a shingles episode.

Skin Tags

A skin tag is a small flap of flesh-coloured skin. It looks like a small droplet or tag of skin.

Skin tags are not painful. Depending on their location, they can catch on:

• jewellery
• zippers
• bra hooks

They occur most often in women and older people.

Urticaria or Hives

Urticaria, also called hives, is a common skin condition involving raised, usually itchy wheals.

A wheal is a circular, red, spongy skin lesion. It develops and changes over minutes to hours.

A wheal usually has an area of redness around it called a flare.

Urticaria commonly results from an allergic reaction to:

• foods such as shellfish
• food additives
• certain plants such as poison ivy
• drugs

Wheals can range from a few millimetres across to an area covering an entire extremity. They can cause severe itching.

Report: If you see signs of urticaria on a client, report them immediately to your supervisor.

Treatment can include antihistamines and topical lotions or creams for itching.

Document: Record what the client has eaten and any substances the client has contacted, such as powders or creams.

Urticaria usually disappears within hours after ingestion.

Supporting Clients With Integumentary Disorders

Skin changes can affect how clients feel about themselves. Clients may feel embarrassed about visible changes.

A client with a contagious condition may also feel embarrassed or angry about having caught an illness from someone else.

Your support should include safety, respect, empathy, and confidentiality.

Protect Against the Spread of Infection

When caring for a client with a contagious illness or infection:

• wear the proper PPE recommended in the care plan
• follow Standard Practices at all times
• change out of your uniform before leaving the agency or client’s home to reduce the risk of spreading pathogens

Use Respect and Empathy

Listen to the client.

Use empathy when speaking with the client. This communicates respect.

Protect Confidentiality

Must: Always follow confidentiality rules.

Never discuss the client or information about the client with anyone who is not involved in the client’s care.