Primary Nursing Diagnosis

Impaired skin integrity related to cutaneous lesions

OUTCOMES. Tissue integrity: Skin and mucous membranes; Wound healing: Primary intention; Knowledge: Treatment regimen; Nutritional status; Treatment behavior: Illness or injury

INTERVENTIONS. Incision site care; Wound care; Skin surveillance; Medication administration; Infection control; Nutrition management

U PLANNING AND IMPLEMENTATION Collaborative

Treatment depends on the patient's characteristics; whether the lesion is a primary or recurrent tumor; and its size, location, and histology. For some primary SCCs and BCCs, therapies may include electrosurgery, surgical excision, cryosurgery, and radiation therapy, which all have comparable cure rates of greater than 90%. Tumors best suited to such methods are generally small, superficial, well defined, and slow growing. Treatment is done on an outpatient basis, unless the tumor involves deep anatomic sites and surgery cannot be performed under local anesthesia. Mohs' micrographic surgery is the preferred procedure for invasive SCCs, incomplete excisions, and recurrences. The procedure is also preferred for BCCs that are greater than 2 cm, are located in high-risk areas, have aggressive morphology, or have ill-defined borders. This time-consuming procedure involves removing a layer of skin, immediately checking the removed tissue for cancer cells, and continuing this process until the removed skin samples are cancer free. Reconstructive surgery may be necessary after Mohs' surgery or extensive excision.

Topical fluorouracil may be used to manage some SCC skin lesions. During treatment, the patient's skin is more sensitive than usual to the sun. Healing generally occurs in 1 to 2 months. With metastatic SCC, radiation, chemotherapy, and surgery may be combined. The chemother-apeutic agent commonly used is cisplatin or doxorubicin, or both. External beam radiation therapy may be used in cases where a tumor is difficult to remove surgically because of its size or location and in situations in which the patient's health precludes surgery. As an adjuvant therapy after surgery, radiation can be used to kill small deposits of cancer cells that were not visible during surgery. Radiation may also be used when NMSC has spread to other organs or to lymph nodes. If the patient undergoes radiation therapy, prepare the patient for common side effects such as nausea, vomiting, diarrhea, hair loss, and malaise.

852 Skin Cancer

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