Melanoma: Decreasing Morbidity And Mortality Rates

Melanoma is a type of skin cancer that produces a new or abnormal growth of melanocytes present in the epidermis, dermis, and sometimes subcutaneous layers of the skin. In the epidermis, melanocytes produce a brown pigment called melanin that gives the skin a tan/brown color. It protects the skin from harmful effects arising from the sun. The American Cancer Society estimates 100,350 new melanomas will be diagnosed in 2020 and 6,850 people are expected to die from it. With Melanoma, there is a DNA mutation in the melanocytes, causing the cells to grow out of control, often secondary to sun exposure and those with a familial history are at higher risk than most. It accounts for 2% of the skin cancers but it is the most lethal because it metastasizes and may travel to other organs. Nurses play an important role in early detection by teaching detection strategies, identifying risk factors, and providing care based on the treatments associated with the disease to decrease morbidity and mortality rates.

To reduce incidence rates importance is placed on early detection. The nurse performs an assessment inclusive of a thorough history, meticulous skin exam, and palpation of lymph nodes. The patient is also taught how to perform a monthly self-skin exam while documenting changes or the appearance of new lesions. For patients with a positive family history of Melanoma, atypical lesions are assessed for. Lesions/moles are examined using an ABCDE (asymmetry, border, color, diameter, and evolving) method and the patient is taught the characteristics of a non-benign mole.

Risk factors for Melanoma include ultraviolet (UV) light exposure, being fair-skinned, natural red/blonde hair, positive family history, being male, people over 50 years of age, history of sunburns, and having freckles. Indoor tanning increases Melanoma risk by 20% (American Academy of Dermatology, 2020). The nurse would make the patient aware of these factors as well as sun-protective behaviors like wearing sunscreen on exposed areas with at least SPF 15 and wearing hats, sunglasses, and other protective clothing to protect skin.

A case study of a 47-year-old woman with a dark mole on her leg went nine months later for a checkup. She didn’t fit the criteria for being at risk for Melanoma, with no family history, symmetrical mole, with regular borders, no freckles, dark hair, and eyes, and never sustained a sunburn. An unusual case, because the patient was not exposed to predisposing factors, being different from the usual cases of the disease. Due to this case, I believe the established criteria for screening Melanoma needs to be revised and expanded to those who do not fit the regular criteria. More patients might be in danger of contracting Melanoma but will not be aware because healthcare staff is not screening every patient and they are not taught for dangerous signs to look for. Therefore, patients usually get diagnosed at later stages where mortality is higher and cannot be cured.

If a suspicious mole is identified, the nurse collaborates with providers for further investigation. If a diagnosis is confirmed through testing, the staging of the moles would follow a TNM (tumor, nodes, metastasis) classification. The TNM criteria describes the amount and spread of cancer in the patient’s body. Nursing care relies greatly on the extent and treatment provided for the patient. Observing the surgical site for postoperative wound infection manifesting as increased drainage or foul odor at the site. Sterile technique skincare for skin grafts related to deep lesions. For patients that require radiation, frequent skin assessments are done to prevent infection over radiated areas. The patient is taught to protect radiated areas from the sun and to avoid lotions on the skin surface. Anticipating the need for emotional support, information of local support groups is provided by the nurse to aid in the patient, and family’s recovery process.

Caucasians possess the highest incidence and mortality rates when compared to African American and Hispanic populations. Minority populations are usually diagnosed at later stages resulting in increased mortality rates. This could be a result of deficient knowledge, corrected by identifying family history, disproving myths, and teaching. Common myths include that people of color or people that do not suntan cannot get the disease. The nurse identifies misinformation, disproves misconceptions, and provides pamphlets the patient/family can refer to for information on their own time. This implies that the proper teaching of preventative measures is more effective at decreasing incidence rates.

Because morbidity and mortality rates primarily depend on knowledgeable healthcare workers nurses must be knowledgeable of the skills needed. If a nurse or doctor is unable to perform a skin assessment accurately or unaware of the parameters for guidance, patients will be undetected. The article by Roebuck addresses the gaps in knowledge and skills current healthcare workers possess. Nurses stated that although patients would benefit from prevention and detection, barriers exist such as lack of national guidelines, low priority among doctors, the belief that patients are fully responsible for prevention. Barriers associated with education continuation are due to lack of money, not knowing where to obtain education and not being able to spend time away from work/home. This article shows that nurses themselves lack the knowledge and are aware of it. If skin assessments are a low priority among doctors, the nurses should advocate for the patient and communicate the importance by collaborating with all providers ensuring they share a common ground. I believe the healthcare system needs to implement yearly retraining to all medical staff to ensure they are kept up to date with current standards and evidence-based care.

In conclusion, Melanoma is a type of skin cancer that is treatable and has a favorable prognosis if caught in the early stages. Therefore, identifying risk factors and teaching about how to decrease risk is essential in decreasing morbidity and mortality rates across the board. Teaching the patients enhances their independence, allowing them to become a reliable asset to aid in the decrease of risk. Barriers in the healthcare system require a reset, retraining needs to be implemented to enhance the quality of care. The screening criteria needs to be expanded to those who don’t fit the likely criteria. Nurses expressed the need for more educational opportunities, hospitals should implement training modules as a refresher. This way, the disease can be identified early and dealt with before it causes significant harm 

16 December 2021
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