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Melanoma: Causes, Symptoms, and Treatment

Discuss about the Evidence Based Nursing Research Plan.

This is an evidence-based plan for the education of client, which is centered, on a 48 years old female named Cassie Grieve. She is diagnosed with Melanoma four years before when she had gone for a biopsy of a mole on her right arm. Melanoma is also sometimes referred to malignant melanoma is one type of cancer which is developed from the cells containing a pigment called melanocytes. Melanocytes are melanin-producing cells present in the bottom layer of the epidermis of the skin. Melanin is a type of pigment principally responsible for the colour of the skin. The skin is mainly affected by melanoma. However, it also occurs rarely in the mouth, intestine, and eye. Reports give evidence that melanoma commonly occurs in the legs of the woman and in the back of the men. In some cases, it is developed from a mole which is concerned with the changes like irregular shapes, increase in size, itchiness, change in colour, etc.  Melanoma is caused mainly due to the exposure to ultraviolet light (Lindqvist et al ., 2014.). The source of UV light may be the sun or other source of UV light. 25% of melanoma occurs in the people, who have a history of affected family members, having weak immune system also are at severe risk, it is also very common among the peoples who many moles in their body. The diagnosis of melanoma is mainly made by biopsy of the concerned lesion.

Melanoma may be prevented by the use of sunscreen or by avoiding exposure to ultraviolet light. The typical treatment of melanoma is removal by surgery.  For the larger cancers, the lymph nodes present nearby should be tested because there remain a chance of spreading. About 90 percent of the patients are cured if they have no spreading of melanoma. But if spreading of melanoma occurs then the use of chemotherapy, biologic therapy, radiation therapy, and immunotherapy can be utilized for the improvement of the survival time of the patient. The spreading of melanoma depends on the thickness of the melanoma and on the rates of the cell division (Jones et al., 2016). It is evident from the reports of 2012 that the most dangerous type of skin cancer is melanoma. About 232000 peoples are reported to have melanoma and among the 55000 died of it (Du et al., 2015). In the world, Australia and New Zealand, have the highest rates of melanoma. Whereas it is less common in Africa and Asia (Ferlay et al., 2015). Melanoma is reported more frequently in men than in woman (Lazovich et al., 2016). 3 to 5 percent of patients having malignant melanoma are reported to have developed further lesion or a different type of skin cancer (Weide et al., 2014).

Case Study: Cassie Grieve

Cassie lives together with her partner named Jason in a longstanding De Facto relationship. For about ten years, she used to smoke two packets of cigarettes every day, but she has stopped it from March 2010. Cassie’s mother stays 20 minutes away from her home. She visits her mother on a regular basis. Her father died of lungs cancer, and her maternal grandmother died of breast cancer. Four years back when she had gone for a biopsy of a mole on her right arm, she was detected with melanoma. At that time, she has gone for a wide excision and biopsy of sentinel lymph node of right axilla, but it gave a negative result for the presence of malignant cells. Previously the medical history of Cassie reveals that she used to have migraine headaches and asthma.

The last four months history of Cassie shows that she had back pain in the right inner lower scapula. This pain occasionally radiates to her right iliac area or her upper ribs. To find out the reason for the pain she had gone for a full body CT scan that revealed that there is large mass in the right lobe of her liver. To get a partial resection of her liver Cassie was admitted in Wide Bay Hospital and after her discharge from the hospital, she says that she has fewer headaches than the usually she used to have. She used to have a dry cough occasionally, but she is having it for last two months. She denies for nausea, haemoptysis, vomiting, Chest or abdominal pain. She also does not have any general weakness or weight loss. On keeping her on observation, it was found that she had a temperature of 36.8°C, Pulse rate of 68 per minute, Blood Pressure of 100/64, and respiratory rate of 16 per minute. Cassie was administered with Panadeine Forte PRN to control her pain. She has to take chemotherapy in two weeks time as an out-patient client. The chemotherapy of Cassie will be of interferon-alpha via a port-a-cath and Dacarbazine for six weeks.

Disfigurement or some death is caused by skin cancer. As the skin cancer occurs on the skin surface so it can be detected as early as it starts to develop. Though 85 to 95 percent of the skin cancer can be cured just by taking some simple precautions (Julien 2013). The nurses specialize in all aspect has a vital role in managing skin cancer. They must know what advice they should provide to the patient. The nurses should keep in knowledge how to avail appropriate services and information to the patient. The nurses are there to implement strategies for the prevention of opportunistic skin cancer.

The Role of Nurses in Preventing Skin Cancer

An educational session on two specific topics of client education should be provided to the patient keeping the fact in mind that individual’s preferred learning style is different because it is totally dependent on the style of learning that how an individual will identifies focuses, gathers and processes information and thus ensures that the new information and skills are learnt in a memorable way. The individuals who are accustomed with visual learning must be taught with the use of images and pictures.  The patient should be taught very vividly about the adverse effect of the UV light on melanoma. The patients also should be taught how to examine pigmented lesions, recognize the sign of melanoma, the patient should be able to understand who is having a risk and know what action should be taken if they found a questionable lesion. The nurses also have to convince the patients and have to change their sun-seeking behavior into the sun avoiding the behavior.  Preventive health strategies are categorized traditionally with respect to the stage of the disease.


The primary strategies include early age health education that influences attitudes and subsequent behaviors to prevent disease before it begins and can be achieved by health promotion and major health campaigns. The primary targets of these health campaigns are the adolescents, children and the parents of them. Especially the children should be protected from the exposure to intense sunlight because the risk of melanoma in late life increases due to the severe blistering suns burns in childhood. It does not mean that people must deny the outdoor leisure time, but they should be acutely aware of the link between excessive sun exposure and skin cancer. Prevention of sun damage during childhood should be emphasizing the most. A very successful strategy that is used in Australian schools is "No Hat, No Play" policy (Parrish et al., 2016). Nowadays the British schools are also using this system. 

The second strategy of effective client education is that the patient should be encouraged to be able to self-examination. It is very much crucial for the community-based nurses that they must have enough knowledge that can identify the suspicious lesion. The nurses see the skins of the patients more than any other health professional, so the knowledge of early clinical signs of skin cancer is very important for the nurses. In some cases, the advanced melanoma cannot be cured, and it is sometimes fatal. In such situations the nurses are required to provide psychological support, holistic care, education and care the patient at the time of decline and death.

Strategies for Effective Client Education


The contributions, the nurses can make to promote a healthy lifestyle and ensure the early detection of skin cancer are: The nurses should encourage the behaviors that will prevent cancer. The nurses are considered as the teacher for the patient in the matter of health issues so it is the basic duty of the nurse teach the patient and as well as the general public about the skin cancer, especially the malignant melanoma also the nurses should explain that skin cancer is curable in most of the cases. The nurse should perform tailored education programs so that they can advocate the early detection of skin cancer. If it is found that the health programs for the promotion of awareness of skin cancer among the peoples are successful, then the nurses need to be made knowledgeable about the skin cancer. The activities should be like such that the nurse must become a role model to the family members of the patient that how she deal with the patient and how she maintain all the activities of the patient so that the patient does not do any such behavior that the patient promotes the chance of relapse of cancer.

To achieve this, it is required to develop an education program for the nurses on the importance of melanomas and skin cancer. This should be presented as a computer slide presentation. So the matter to be taken into consideration are firstly is to protect the skin from the damaging sun rays. The medication must be done cautiously because there are some medicines, which can generate photosensitivity (Long et al., 2016).


Tanning beds should be avoided, as they are responsible for the emission of ultraviolet rays that are more intense than that are emitted from the sun (Oboite & Love 2016). Lastly, it is very important to take a monthly skin examination which starts from the head and ends at toes (Di Franco et al ., 2013). Early detection is the key to survival so mirrors must be used check areas which are difficult to see (De Angelis et al., 2014).

Reference:

De Angelis, R., Sant, M., Coleman, M. P., Francisci, S., Baili, P., Pierannunzio, D., ... & Bielska-Lasota, M. (2014). Cancer survival in Europe 1999–2007 by country and age: results of EUROCARE-5—a population-based study. The lancet oncology, 15(1), 23-34.

Di Franco, R., Sammarco, E., Calvanese, M. G., De Natale, F., Falivene, S., DiLecce, A., ... & Muto, P. (2013). Preventing the acute skin side effects in patients treated with radiotherapy for breast cancer: the use of corneometry in order to evaluate the protective effect of moisturizing creams. Radiation Oncology, 8(1), 1.

Du, F., Yang, M., Fang, J., & Jing, C. (2015). Primary hepatic malignant melanoma: a case report. International journal of clinical and experimental pathology, 8(2), 2199.

Ferlay, J., Soerjomataram, I., Dikshit, R., Eser, S., Mathers, C., Rebelo, M., ... & Bray, F. (2015). Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. International journal of cancer, 136(5), E359-E386.

Jones, A. M., Ferguson, P., Gardner, J., Rooker, S., Sutton, T., Ahn, A., ... & Kenwright, D. (2016). NRAS and EPHB6 mutation rates differ in metastatic melanomas of patients in the North Island versus South Island of New Zealand. Oncotarget, 5.

Julien, R. M. (2013). A primer of drug action: A concise nontechnical guide to the actions, uses, and side effects of psychoactive drugs, revised and updated. Holt Paperbacks.

Lazovich, D., Vogel, R. I., Weinstock, M. A., Nelson, H. H., Ahmed, R. L., & Berwick, M. (2016). Association between indoor tanning and melanoma in younger men and women. JAMA dermatology, 152(3), 268-275.

Lindqvist, P. G., Epstein, E., Landinâ€ÂOlsson, M., Ingvar, C., Nielsen, K., Stenbeck, M., & Olsson, H. (2014). Avoidance of sun exposure is a risk factor for allâ€Âcause mortality: results from the Melanoma in Southern Sweden cohort. Journal of internal medicine, 276(1), 77-86

Long, M., Weaver, K., Kappelman, M., Herfarth, H., & Pipkin, C. (2016). P-047 Pilot Study of Skin Cancer Risk Factors and Photosensitivity in Patients with Inflammatory Bowel Disease Newly Initiating Immunosuppression.Inflammatory Bowel Diseases, 22, S24.

Oboite, M. E., & Love, P. B. (2016). Discoid Lupus Erythematosus. InClinical Cases in Skin of Color (pp. 3-13). Springer International Publishing.

Parrish, A. M., Okely, A. D., Batterham, M., Cliff, D., & Magee, C. (2016). PACE: A group randomised controlled trial to increase children's break-time playground physical activity. Journal of Science and Medicine in Sport,19(5), 413-418.

Weide, B., Eigentler, T. K., Pflugfelder, A., Zelba, H., Martens, A., Pawelec, G., ... & Gutzmer, R. (2014). Intralesional treatment of stage III metastatic melanoma patients with L19–IL2 results in sustained clinical and systemic immunologic responses. Cancer immunology research, 2(7), 668-678.

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