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

2. Objectives
Skin Cancer Prevention
Skin Cancer Screening
Skin care

3. 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

4. Sun Exposure Lifetime UV Exposure in the United States
Age of Average Accumulated Exposure*
percent
percent
percent
percent

5. 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

6. 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

7. 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

8. 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

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

10. 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

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

12. Pictures

13. 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

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

15. 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

16. 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

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

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