Skin Cancer & Melanoma Nursing Care

Basal cell carcinoma (BCC) is the most common skin cancer — slow-growing, rarely metastasizes; classically a pearly, translucent papule with rolled borders and telangiectasias that may ulcerate. Squamous cell carcinoma (SCC) is the second most common — a scaly, crusted, or ulcerated firm lesion on sun-exposed skin (and lips/ears); it can metastasize, especially in the immunosuppressed.

Melanoma is less common but the deadliest — arising from melanocytes, it can metastasize early and widely. It often presents as a new or changing pigmented lesion. The depth of invasion (Breslow depth) drives prognosis — which is exactly why early detection saves lives.

During any skin assessment, note new, changing, non-healing, or bleeding lesions; apply ABCDE and the ugly-duckling sign to pigmented lesions; and inspect the high-yield spots — face, ears, lips, scalp, dorsal hands, lower legs, and the hidden acral sites. Document size, color, borders, and any change over time (a photo helps). Identify risk factors and review the patient’s sun history and self-exam habits. Post-operatively, assess the excision/graft site, margins status, and for melanoma, the nodal basin and signs of recurrence on follow-up.

Reactions split two ways: some patients dismiss skin cancer as “just a spot,” others hear “melanoma” and assume a death sentence. Calibrate — emphasize how curable early disease is while taking suspicious lesions seriously enough to act. Sun-safety teaching can feel like scolding; frame it as protecting the skin they have rather than blaming past sunburns. For a melanoma diagnosis, pace information, provide hope grounded in early-stage cure rates and modern therapies, and connect to oncology support.

Teach monthly skin self-exams using ABCDE and the ugly-duckling rule, and to report new, changing, non-healing, or bleeding lesions promptly — including under nails and on soles. Drill sun protection: sunscreen SPF 30+ reapplied every 2 hours and after swimming/sweating, shade and protective clothing, avoiding midday sun, and never using tanning beds. For those treated, stress lifelong dermatology surveillance (history of one skin cancer raises the risk of another), and for melanoma survivors, the follow-up schedule and what recurrence might look like. Encourage protecting children, since childhood sun exposure drives lifetime risk.