Healthy Skin Valerie Dzubur EdD APRN-FNP-BC Samuel Merritt University Originally developed by Dr. Cecily Cosby for FNP

Objectives Skin Cancer Prevention Skin Cancer Screening Skin care

Epidemiology 2 million people with a new diagnosis annually More than breast, prostate, lung, and colon combined 1 in 5 Americans will get skin cancer 2004 direct cost 1 billion dollars basal and squamous 90 % aging skin & cancer due to sun exposure 10k deaths per year (8.5 melanoma) Most common and most preventable form of cancer

Sun Exposure Lifetime UV Exposure in the United States Age of Average Accumulated Exposure* 1-18 22.73 percent 19-40 46.53 percent 41-59 73.7 percent 60-78 100 percent

Skin Cancer Prevention Primary Counsel on sun avoidance Secondary Screen for lesions with malignant features Refer Tertiary Remove precancerous lesions such as actinic keratoses and suspicious moles

Skin Cancer Prevention The Sun Damages the DNA < 6 mos old no direct sun exposure Children avoid sunburn Children get melanoma too 24 hours for sun burn to appear Even children with darker skin need sunscreen Clouds don’t block sun exposure

Skin Cancer Prevention Avoid mid-day sun 10 am – 4 pm Use SFP 15 or > (blocks 95% of the suns rays) Block some UVA, most UVB Protective clothing Quit smoking Avoid industrial carcinogen exposure Avoid tanning lights

Healthy Skin Sun Screen Absorbs scatters or reflects light Apply 30 minutes before exposure Use adequate amounts Re-apply every 2 hrs Expiration - 3 yrs

Skin Cancer Screening Asymmetry Borders Color variegation Diameter => 6mm (pencil eraser or larger) Elevation / Evolving Low degree of suspicion for biopsy

Skin Cancer Melanoma Vast majority caused by ultraviolet radiation Incidence in increasing & in under reported 68,720 new dx 3 % of skin cancer & 75 % of the deaths Early detection is key Punch biopsy is simple send for pathology One blistering sunburn in childhood 2 x the risk 5 or more sunburns at any time doubles the risk

Melanoma On the rise both in terms of rates and death 1930 1 in 1,500

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Skin Cancer Basal Cell 2.8 million BCC diagnosis annually If allowed to grow can be disfiguring Tx – removal 40 – 50 % of Americans who live to 65 yrs-old

Skin Cancer Squamous Cell 700,000 dx annually 2,500 deaths Actinic Keratoses all becomes cancer

Skin Cancer Ethnicity Asian, African America, Latino present with more advanced disease Death rate from melanoma is higher Skin lesions presents on non-sun exposed areas Palms, soles of feet, nails, mucous membranes

Skin Cancer Screening Identify high risk patients Light hair, blue eyes Inability to tan Smoking Immunosuppression Intense, intermittent sun exposure Industrial carcinogen exposure Working outdoors History of sunburn Family History of melanoma

Acne Prevention Early Treatment Quality of life Self Esteem Prevent Scarring Refer to dermatology for Rx acutane

Skin Care Big Business Acne preparations Care Products Anti-aging Cleansers Moisturizers Make-up Anti-aging Alpha hyrox Glycolic acids Retinoic acids