Primary Nursing Diagnosis

Impaired skin integrity related to cutaneous lesions

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

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


After diagnostic testing, the cancer is staged. Because the thinner the melanoma, the better the prognosis, the Clark level of a melanoma may be used. This system uses a scale of 1 to 5 to describe which layers of skin are involved. The higher the number, the deeper the melanoma.

The primary treatment for melanoma is surgical resection. Excision of the cancerous lesion with a 2- to 5-cm margin is recommended when feasible. The width of the surrounding margin should be wider for larger primary lesions. When the melanoma is on a finger or toe, surgical treatment is to amputate as much of the finger or toe as is necessary. Elective regional lymph node removal is controversial. Proponents believe that this procedure decreases the possibility of distal metastases, but scientific evidence to support this belief is lacking.

The prognosis for metastatic melanoma is poor; it is highly resistant to currently available chemotherapeutic agents. Radiation is not often used to treat the original melanoma, but is rather used for symptom management as a palliative measure if the cancer has spread to the brain.

604 Melanoma Skin Cancer



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