By Jessica Foster, Shelby Phillips, Saxxon Winkel

BSN Students

University of Southern Indiana

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The purpose of this article is to describe how to perform a thorough skin assessment, the importance of assessing the skin monthly, and to describe ways to protect the skin. Skin health is essential for a person’s well-being throughout the lifespan (Cowdell, 2010). Skin cancer is the most common cancer with approximately 1,000,000 people developing the disease each year (Kuhrik, Seckman, Kuhrik, Ahearn, & Ercole, 2011).  As the skin ages, it is more difficult for the skin to serve as a barrier and skin breakdown may become more evident.  It is important to examine the skin carefully, assessing for new or changing appearance of skin characteristics, including lesions, and moles.

  Any time a skin assessment is completed, it is important to maintain the person’s dignity and minimize embarrassment throughout the examination (Cowdell, 2010). Before examining the area explain to the person what the examination focuses on and what areas will be assessed.  The Skin Cancer Foundation (2016b) recommends that head-to-toe skin assessments should be performed monthly to identify early warning signs of skin cancer or altered skin integrity.

To begin a skin assessment, first examine the face including the nose, mouth, lips, and ears, making sure to look behind the ears (Skin Cancer Foundation, 2016b).  If necessary, a mirror may be used to see all angles.  It is important to note any changing moles or open areas present on any of these locations.  Next, inspect the scalp for any discolorations, lumps, or bumps.  In order to get a thorough assessment of the scalp, a hair dryer may be used to help move the hair to see the region better.  After examining the scalp, check the hands carefully, front and back and between the fingers.  Continue to look at the wrists and forearms remembering to look closely at each mole present.  Begin to examine the elbows and upper arms, not to forget the underarms. Next, focus on the neck, torso, and chest area (Skin Cancer Foundation, 2016b).  If necessary, lift the breasts to view the underside.  Areas of additional importance are the back or the neck, shoulders, upper back, buttocks and back of the legs that are often neglected in a skin assessment.  Once again, a mirror may be used in order to see all necessary angles and to perform a thorough assessment.

Lastly, it is important to sit down and prop each leg up on a stool or a chair. Examine the soles of the feet, heels, and under the toenails and between each toe.  Foot care is essential in the elderly population and it is important to note if there is any numbness, tingling, or pain in any areas of the foot (Yetzer, 2004). Numbness in the lower extremities may cause an increased risk of skin alterations going unnoticed in these areas. As it is recommended for monthly skin assessments to be performed, foot inspections are recommended to be performed daily.  This recommendation is due to the constant wear and tear that individual’s feet go through on a daily basis.  It is necessary to inform the healthcare provider about any non-healing wounds on the feet.

During the skin assessment, if a mole is found, an additional assessment process should be performed for each mole to check for any abnormalities.  The ABCDE model is an assessment tool commonly used (Skin Cancer Foundation, 2016a).  The first letter is for asymmetry (A) which can be assessed by imagining a line drawn through the middle of the mole.  The two sides should match and be symmetrical.  If the mole is asymmetrical, further assessment should be performed.  The next part of the mole assessment involves the border (B) of the mole.  A non-cancerous mole has a smooth and even border.  Often, the border of an early cancerous (malignant) mole tends to be uneven.  Along with assessing the border, the color (C) of the mole should be observed. Normally, a mole should be all one color, often a shade of brown.  Having many colors is an early warning sign of melanoma, a cancerous skin condition.  Next, look at the diameter (D).  Many non-cancerous moles have a smaller diameter than malignant ones.  Melanomas are often larger than an eraser on a pencil (Skin Cancer Foundation, 2016a).  Lastly, check if the mole is evolving (E).  Normal moles that cause no concern usually look the same over an extended period of time.    When an abnormal mole has evolved or changed in size, shape, color, diameter, or symmetry, call a healthcare provider for further assessment.

If the skin is in good condition, it is important to maintain healthy skin using the following suggestions.  Good skin health is important and you can maintain this level of healthy skin by using the following suggestions (Cowdell, 2010).  Bathing can help keep the skin hydrated and clean.  Applying lotion to the skin is another great way to maintain skin hydration and prevent excessive dryness.  When going outside during the day, it is important to wear appropriate sunscreen to decrease the chances of skin cancer by blocking sun rays.  Wearing long sleeved shirts and hats to help protect the face will also help protect the skin from the sun’s harmful rays.

In conclusion, performing thorough skin assessments on a monthly basis will allow individuals to recognize early warning signs of troubling or worsening skin conditions.  By following the full head-to-toe model for the skin assessment, all areas of the body will be thoroughly observed.  For each mole found, the ABCDE model can be applied to the assessment to further identify any abnormal moles.  While assessing the skin, it is always important to look at the feet.  The current recommendation is for individuals to inspect their feet daily.  By taking care of the skin through bathing, using lotions and sunscreen, and by wearing proper clothing while in the sun, an individual’s skin cancer risk will decrease.

 

 

Jessica Foster, BSN Student

Shelby Phillips, BSN Student

Saxxon Winkel, BSN Student

Pam Thomas, MSN, RN, CCRN

Charlotte Connerton, EdD, RN, CNE-BC

University of Southern Indiana College of Nursing and Health Professions

 

References

Cowdell, F. (2010). Promoting skin health in older people. Nursing Older People, 22(10), 21-26. Retrieved from http://www.rcn.org.uk

 

Kuhrik, M., Seckman, C., Kuhrik, K., Ahearn, T., & Ercole, E. (2011).  Bringing skin assessments to life using human patient simulation: An emphasis on cancer prevention and early detection. Journal of Cancer Education, 26(4), 687-93. http://dx.doi.org/10.1007/s13187-011-0213-3

Skin Cancer Foundation. (2016a). Do You Know Your ABCDEs. Retrieved from http://www.skincancer.org/skin-cancer-information/melanoma/melanoma-warning-signs-and-images/do-you-know-your-abcdes

Skin Cancer Foundation. (2016b). Step By Step Self-Examination. Retrieved from http://www.skincancer.org/skin-cancer-information/early-detection/step-by-step-self-examination

Yetzer, E. (2004). Incorporating foot care education into diabetic foot screening. Rehabilitation Nursing, 29(3), 80-84. http://dx.doi.org/ 10.1002/j.2048-7940.2004.tb00315.x

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