1. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Assessment (NUR 230) The Skin, Hair, and Nails Lecture 2

2. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy and Physiology Major function of skin is to keep the body in homeostasis –Protects underlying tissues from microorganisms, harmful substances, and radiation –Modulates body temperature –Synthesizes vitamin D

3. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy and Physiology (cont.) Three layers –Epidermis –Dermis –Subcutaneous tissue Hair, nails, and sebaceous and sweat glands are appendages of skin

4. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Anatomy and Physiology (cont.) Hair –Vellus hair – short, fine, less pigmentation –Terminal hair – coarser, pigmented (scalp/eyebrows) Nails - protect distal ends of fingers/toes

5. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins The Health History Common or concerning symptoms –Hair loss –Rash –Moles Ask the patient –“Have you noticed any changes in your skin or your hair?” –“Have you noticed any moles that have changed size, shape, color, or sensation?” –“Have you noticed any new moles?”

6. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Health Promotion and Counseling Clinicians play an important role in educating patients –Early detection of suspicious moles –Protective measures for skin care –Hazards of excessive sun exposure Skin cancers are most common cancers in the U.S. –Most prevalent on hands, neck, and head

7. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Skin Cancers Basal cell carcinoma –Comprises 80% of skin cancers –Shiny and translucent, they grow slowly and rarely metastasize Squamous cell carcinoma –Comprises 16% of skin cancers –Scaly, and ulcerated, they can metastasize Melanoma –Comprises 4% of skin cancers –Rapidly increasing in frequency, they spread rapidly

8. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Risk Factors for Melanoma History of previous melanoma Age over 50 Mole changing Male gender

9. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Additional Risk Factors for Melanoma Red or light hair Heavy sun exposure (especially severe childhood sunburns) Light eye or skin color Family history of melanoma

10. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins ABCDE: Screening Moles for Possible Melanoma A for asymmetry B for irregular borders, especially ragged C for variation or change in color, especially blue or black D for diameter ≥6 mm or different from other moles, especially changing, itching, or bleeding E for elevation or enlargement