Melissa A. Grier, MSN, APRN, ACNS-BC
Oncology nurses have the unique opportunity to educate patients and their loved ones about the dangers of excess sun exposure. We can provide this education at the bedside and through our own positive example when we're out and about under the sun.
The Different Types of Skin Cancer
Unrepaired damage to DNA in our skin caused by too much exposure to ultraviolet radiation (ie, sunshine and tanning beds) can lead to genetic mutation and rapid growth of abnormal cells, ultimately resulting in malignancy.
Abnormal skin lesions are classified as “precancerous” and “cancerous.” The precancerous variety includes actinic keratosis and dysplastic nevi (atypical moles). The presence of either of these places a person at higher risk for developing skin cancer.
Basal cell carcinoma, the most commonly occurring form of skin cancer, originates in the deepest layer of the epidermis. These cancerous lesions are the result of cumulative or occasional intense sun exposure. Squamous cell carcinoma is the second most common skin cancer and results from cumulative sun exposure over the course of a lifetime. Melanoma is the most dangerous type of skin cancer. It originates in melanocytes, the pigment-producing cells within the basal layer of the epidermis. When detected early, melanoma is typically curable. However, when undetected, it can metastasize to other parts of the body and becomes more difficult to treat and cure. Merkel cell carcinoma is a very rare and aggressive form of skin cancer that typically affects fair-skinned individuals over the age of 50.
Sun Protection TechniquesSun protection and skin cancer prevention techniques may seem obvious to us as healthcare professionals, but our patients may never have received this education. The basics should include seeking shade between 10 am and 4 pm.
Daily use of a broad-spectrum (Ultra Violet A&B) sunscreen with an SPF of at least 15 should be recommended for the areas of skin that are most frequently exposed to the sun (face, ears, neck, etc). During extended, intense exposure, an SPF of 30 or higher is recommended 30 minutes prior to sun exposure. Reapplication should occur every 2 hours or immediately after swimming or excessive sweating. Sunscreen should be used on infants over 6 months old; newborns should be protected from sun exposure. Protective clothing, such as lightweight long-sleeved shirts, wide-brimmed hats, and sunglasses with UVA/UVB protection should also be encouraged. Finally, a monthly skin self-exam and a yearly visit to a physician or dermatologist for a thorough skin assessment are recommended.
Patients in Active TreatmentPhotosensitivity or sunburn occurring after minimal sun exposure, is a known side effect associated with certain types of certain anticancer therapies. High-soder methotrxate, dacarbazine, 5-Flourouracil, trans retinoic acid, and vinblastine are chemotherapy agents known to cause photosensitivity. Cetuximab, panitumumab, vandetanib, and vemurafenibare biotherapy agents and targeted therapies associated with photosensitivity. Patients receiving active treatment with any of these agents should receive education about sun protection prior to starting treatment, with follow-up education provided periodically throughout the treatment regimen.
FROM EVIDENCE TO REALITY: “POOL COOL” IN KANSAS
In 2014, an oncologist at the University of Kansas Cancer Center approached Ashley Adorante, outreach coordinator for the Midwest Cancer Alliance, about implementing Pool Cool, a research-tested program that teaches children, their parents, and aquatics staff at local pools about sun safety.
The program is based on research published by the University of Pennsylvania in 2002. Aquatics instructors working at community pools receive training through a “train-the-trainer” model, which also helps them implement the preventive measures in their own lives. A series of eight 5-minute lessons are then taught by the aquatics instructors prior to swimming lessons. Along with the lessons, sun protection resources are offered at pools participating in the program—including large jugs of sunscreen, Pool Cool signs, shade areas, and other promo- tional items.
Adorante took the oncologist’s request to the Kansas City Metro Aquatics Council and got the program rolling. In its first year, Pool Cool was implemented at 21 pools in the Kansas City area. By 2015, a total of 33 pools across the state were participating. Last year, approximately 40 pools joined, and the goal for 2017 is to bring Pool Cool to another 50 community pools across Kansas.
Adorante says the program has now been implemented in western Kansas, a sparsely populated region with many small rural communities. In communities without public pools, lunch and learn programs about sun safety have been provided to city workers who spend the day working outdoors.
The Kansas Pool Cool program receives its funding from the Midwest Cancer Alliance, Kansas Cancer Partnership, and Outpacing Melanoma. For more information about implementing Pool Cool in your community and state, email Ashley Adorante at firstname.lastname@example.org.
More information about skin cancer, prevention, and treatment is available through the Skin Cancer Foundation at skincancer.org.