Clinical Nurse Specialist Kingston Hospital NHS foundation trust - - PowerPoint PPT Presentation

By Kate Mayers Macmillan Skin Cancer Clinical Nurse Specialist Kingston Hospital NHS foundation trust

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CLINICAL PRESENTATION “SCC usually presents as an indurated nodular keratinising or crusted tumour that may ulcerate, or it may present as an ulcer without evidence of

• keratinisation. Possible cutaneous SCC should be

referred urgently to an appropriately trained specialist, usually in the local Dermatology Department, rapid access skin cancer clinic”.

Motley, Preston & Lawrence (2009) B.A.D SCC guidelines.

Squamous Cell Carcinoma

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“A specialist or appropriately trained clinical nurse specialist or primary care physician may undertake regular follow-up examination for recurrent disease” Motley, Preston & Lawrence, (2009). BAD SCC guidelines. All patient’s diagnosed with SCC at Kingston Hospital are discussed at our local skin cancer MDT. A patient diagnosed with a low risk, primary SCC, can be discharged back to their GP, to continue 3 monthly follow up for oncological surveillance for approximately two years.

Squamous Cell Carcinoma

 Low Risk SCC

Arising at sun exposed sites excluding lip and ear Tumours up to 20 mm in diameter. Tumours up to 4 mm in depth and confined to dermis No evidence of immune dysfunction Well differentiated tumour or Verrucuous subtype

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 SCC diagnosis – verbal and written information.  Skin examination  Lymph nodes  Education on self examination  Advice and education on sun awareness  Holistic Needs Assessment  Clinical Nurse Specialist/department contact details

MDT follow up

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 See the patient and explain the diagnosis.  Skin examination in clinic, we ask the patient to undress down to his underwear including his socks and shoes.  Check the scar site to see its healed well, any sign of local recurrence.  Examine all the skin, systematically checking from head to toe, front to back.  A good time to reassure the patient of what is normal (benign lesions) and what to look out for.

Examination

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 1: A persistent Scaly patch Often red in colour, with uneven borders Look out for a scaly patch of skin that won't heal Often these patches will crust and bleed  2: An elevated growth with central depression Growths are raised with an indentation to the centre Growths can sometimes bleed They can grow rapidly in size  3: Open sore Look out for an open sore-like wound A sore that constantly crusts and bleeds A persistent sore that won't heal over weeks  4: A wart-like growth Look out for a growth that resembles a wart A growth that crusts and sometimes bleeds A wart-like growth that won't heal or respond to treatment (http://www.skcin.org/typesOfSkinCancer/NonMelanomaSkinCancers.htm)

Early signs of SCC

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Example leaflet given to SCC patients (www.wessexcancer.org.uk)

Checking the lymph nodes

 Checking the lymph nodes

(www.wessexcancer.org.uk)

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 Effective assessment and care planning is used to identify people’s concerns and needs can lead to early interventions, diagnosis of consequences of treatment, improved communication and better equity of care.  Everyone with cancer should be offered a Holistic Needs Assessment (HNA) and a care plan to set up a recovery package (health and well being, support). (Young, N. 2012.http://www.macmillan.org.uk)

Holistic Needs Assessment

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Providing the time to assess the patient’s holistic needs enables us to identify any immediate concerns or distress from the patient and create a care plan. Such as:  Further support from a clinical nurse specialist,  Counselling,  Armed forces and War Veterans payments.

HNA

 HNA

 HNA

(Young, N. 2012.http://w ww.macmillan.

• rg.uk)

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A treatment summary is completed following treatment, then shared with the person living with cancer and sent to their GP.  A Cancer Care Review completed by the GP or Practice Nurse to discuss needs. This should happen within 6 months of the GP practice being notified that the person has a cancer diagnosis.  An education and support event. Eg: Health and Wellbeing clinics, to prepare the person for transition to supported self management.  Complimenting Stratified care pathways.

Macmillan (2014) Sharing good practice. MAC1574.

Treatment summary

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QUESTIONS? ???

Thank you