Primary Skin Cancer: Types of Wounds You Might Encounter

Published on November 18, 2020 by Carole Jakucs, MSN, RN, PHN

primary skin cancer

No matter your practice environment, you’ll likely encounter patients with wounds related to primary skin cancer at some point.

To learn more about primary skin cancer wounds, we spoke with Joni Brinker, MSN/MHA, RN, WCC, an Ohio-based consultant and clinical nurse educator with Optum Hospice Pharmacy Services of Eden Prairie, Minnesota.

She also spoke during a session at our Wild on Wounds (WOW) national conference, for an overview of the need-to-know fundamentals.

Skin cancer is the most common cancer in humans, Brinker said. “Generally, skin cancers are seen in older patients, so if you’re working with the elderly such as in long-term care, you’ll likely see skin cancers.”

Brinker said the three major types of primary skin cancer are:

  1. Basal cell carcinoma
  2. Squamous cell carcinoma
  3. Malignant melanoma

“When working in hospice, it’s more likely you’ll see patients with malignant melanoma that has metastasized,” Brinker said. “If you see patients with basal and squamous cell carcinomas in the hospice environment, they are typically a secondary diagnosis.”

Main types of skin cancers

Basal cell carcinoma

Basal cell carcinoma is slow-growing and seldom spreads. “It’s very treatable if caught early,” Brinker said. “If you see a patient with a basal cell carcinoma that has advanced, they had it for a long time.”

Identifying basal cell carcinoma can be very difficult, Brinker said. “It’s important to have the patient see a dermatologist for any wounds that have not resolved to obtain a correct diagnosis.”

Basal cell carcinoma can present in a variety of ways:

  • Pimple-like lesion
  • Non-healing sore
  • Shiny appearance
  • Raised
  • Brown
  • Scaly patch of dry skin
  • Moles
  • Scar appearing wound

Squamous cell carcinoma

Squamous cell carcinoma is found in the skin, but it also can line other organs such as the lungs, for example. As with basal cell carcinoma, squamous cell carcinoma is slow-growing. However, if left untreated, it can spread, Brinker said.

“Squamous cell carcinomas are typically found in areas of the body previously exposed to sunlight so may be found on the face, head, and neck,” Brinker said. “Human papilloma virus can also cause squamous cell carcinoma, so we sometimes see them in the mouth or genitalia.”

Squamous cell carcinoma can present in different ways such as:

  • Rough red patch of skin
  • Discolored fingernail
  • Ulceration
  • Non-healing sore
  • Horn-like appearing structure
  • Brown
  • Hard texture

As with basal cell carcinoma, squamous cell carcinoma can have many non-specific symptoms. Patients need an exam with a dermatologist to obtain an accurate diagnosis, Brinker added.

Malignant melanoma

The most feared skin cancer is malignant melanoma because it can spread to other parts of the body. “It’s aggressive and deadly,” Brinker said. “If malignant melanoma is suspected, a consultation with a dermatologist is essential for early diagnosis and treatment.”

Malignant melanoma is treatable if caught early, removed surgically, and findings result in clear margins.

“It can present as a new mole or numerous moles, or pigmented areas of skin,” Brinker said. “The pneumonic ABCDE is used to help identify it.”

The definitions in the pneumonic below are adapted from the American Academy of Dermatology Association.

  • Asymmetrical: Each half of the area in question is different from the other half.
  • Border: The outer border of the concerning spot is not clearly defined or has an irregular or scalloped shape.
  • Color: The lesion has different colors throughout and can vary from altering shades of black, brown, or tan, or have areas ranging from blue, red, or white.
  • Diameter: The size of most melanomas is typically larger than six millimeters. However, some present smaller.
  • Evolving: The mole-appearing lesion in question looks different from other moles or is exhibiting ongoing changes in its color, shape, or size.

Common wound care for primary skin cancer

A wide range of treatments are provided by physicians for different skin cancers. These consist of radiation therapy, various surgical procedures, and topicals.

Wound care clinicians typically employ various treatments including a variety of topicals and dressings.

Regardless of the type of primary skin cancer, these wounds can bleed.

“When this is the case, absorbable hemostatic sponges can be used as needed,” Brinker said. “Adjunctive treatments to consider are calcium alginate dressings and oxymetazoline (Afrin).”

Basal and squamous cell carcinomas

Basal and squamous cell carcinomas are often seen in long-term care, Brinker said, and products that are typically used for more superficial wounds are imiquimod and fluorouracil.

These each have a specific use and must be administered according to the instructions on the label, Brinker said.

As a wound care clinician, you’ll want to monitor lesions. If they open up and become wounds, treat the wound according to the condition of the wound bed, she said.

“A dry wound is better,” Brinker said. However, if wet, I use absorptive dressings. And if the wound is on the face, I try to match the patient’s skin color.”

Malignant melanoma

The primary treatment for malignant melanoma is surgery, Brinker said. “Surgery typically involves a small incision and wound care, but these patients are not usually seen in a typical wound care setting.”

In addition to surgery, some patients receive radiation therapy. Radiation therapy may be used in any of the three primary skin cancers, she said.

These patients may be seen by wound care clinicians if they develop radiation dermatitis.

Radiation dermatitis is typically a mild dermatitis, presenting with mild erythema, and dry, flaky skin.

“I typically use Aquaphor lotion along with a hydrocortisone cream for these patients,” Brinker said.

Radiation dermatitis can present in a more severe form and can cause an open wound, requiring the use of non-adherent dressings, or a full-thickness wound requiring more intensive treatment such as surgery, she said.

“More severe cases of malignant melanoma can produce painful, malodorous and heavily exudative wounds,” she said. “Each case and its treatments are unique and specific to each patient.”

For advanced cases of malignant melanoma, the treatments may last longer than the patient’s life expectancy.

Even if that is the case, palliative care is provided to reduce pain and improve the patient’s quality of life. It may consist of a combination of surgical, radiation, and chemo therapies, Brinker said.

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Carole Jakucs

Carole Jakucs, MSN, RN, PHN, is a full-time freelance writer. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, pediatric emergency department and college health. 

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