Kristen Mauk

About Kristen Mauk

President/CEO - Senior Care Central, LLC

Skin Cancer in Older Adults

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Background

There are three major types of skin cancer: basal cell, squamous cell, and malignant melanoma (MM). Basal cell carcinoma is the most common skin cancer, accounting for 65–85% of cases (Kennedy-Malone et al., 2000). According to the American Cancer Society (2013), more than 3.5 million cases of basal cell and squamous cell skin cancer are diagnosed every year. Squamous cell carcinoma is more common in African Americans and is also less serious than malignant melanoma. Malignant melanoma accounts for only 3% of all skin cancers, but it is responsible for the majority of deaths from skin cancer. Older adults are 10 times more likely to get MM than adults under age 40 (Johnson & Taylor, 2012). About 8,420 people were estimated to die from malignant melanoma in 2008. The American Cancer Society (2013) estimated that in 2013 there would be over 76,000 new cases of malignant melanoma in the United States.

Risk Factors

Older adults are more susceptible to skin cancers because of a variety of factors. These include exposure to carcinogens over time (such as through sunburn or tanning booths) and immunosenescence, or a decline in immune function. Family history of skin cancers, multiple moles (more than 100), and pale skin also put a person at higher risk. The major risk factor for all types of skin cancer is sun exposure.

Warning Signs

The ABCDE method can help people remember the warning signs of skin cancer:
A = Asymmetry (if a line is drawn down the middle of the lesion, the two sides do not match)
B = Border (the borders of the lesion tend to be irregular)
C = Color (a variety of colors is present; the lesion is not uniform in color)
D = Diameter (MM lesions are usually larger)
E = Evolving (note any changes in shape or size, or any bleeding)

Diagnosis

Annual physical examinations should include inspection of the skin for lesions. Older adults should be taught to report any suspicious areas on their skin to the physician. Persons should particularly look for changes in shape, color, and whether a lesion is raised or bleeds.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common kind of skin cancer. It is often found on the head or face, or other areas exposed to the sun. Although there are different forms of BCC, the nodular type is most common, and appears as a raised, firm, papule that is pearly or shiny with a rolled edge. (Johnson & Taylor, 2012). Patients often complain that these lesions bleed and scab easily. When treated early, it is easily removed through surgery and is not life threatening, though it is often recurring.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) also appears as lesion on areas of the body exposed to the sun, or from other trauma such as radiation. HPV is a risk factor of SCC, and metastasis is more common than with BCC. The lesions of SCC appear scaly, pink, and thicker than BCC. Their borders may be more irregular and the lesions may look more like an ulceration.

Malignant Melanoma

Malignant melanoma MM has a more distinctive appearance than other types of skin cancer. The areas appear asymmetric with irregular borders, a variety of colors (including black, purplish, and pink), and size greater than 6 mm. Malignant melanoma MM is often identified with the ABCDE method and MM accounts for the vast majority of deaths from skin cancer. The good news is that MM is almost always curable when found early. A skin check should be part of an older person’s yearly physical.

Treatment

The best treatment for skin cancer in the elderly is prevention. All older persons, especially those with fair skin who are prone to sunburn, should wear sunblock and protective clothing. Most skin cancers, when treated early, have a good prognosis.

All skin lesions larger than 6 mm, or those with any of the ABCDE signs, should be referred for biopsy. There are many nonsurgical interventions. These include cryotherapy, radiotherapy (for superficial BCC or SCC), electrodessication and curettage, and topical treatments. Topical treatments are generally not as effective as more aggressive interventions, but research is ongoing in this area.

The prognosis for MM depends on the extent and staging of the tumor, but when caught very early, the cure rate is nearly 100%. Malignant melanoma MM presenting in older adults is often more advanced and aggressive. Malignant melanoma MM metastases sites are typically the lymph nodes, liver, lung, and brain (Johnson & Taylor, 2012). Surgical treatment is required in malignant melanoma, with chemotherapy and radiation. Adjuvant treatments for MM are also often used.

For more information on Skin Cancer, visit the American Cancer Society at:
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/

 

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By | 2017-06-04T17:07:03+00:00 June 4th, 2017|News Posts|Comments Off on Skin Cancer in Older Adults

Nurses Are….

This week we celebrate National Nurse’s Week beginning on May 6th and ending on May 12th (Florence Nightingale’s birthday). The profession of nursing has come far since its inception. When I went to nursing school in the late 1970’s, we were still wearing blue pin-striped uniforms and caps. There were striping and pinning ceremonies to mark milestones in the 4 year journey to the Bachelor of Science in Nursing degree, and it wasn’t until the early 1980’s when my nursing school started to eliminate those bulky caps that were so difficult to keep on our head. When the mandatory uniforms and nursing caps were no longer the symbol of the nurse, we had to develop other ways for patients and families to recognize us. I hope that we are now recognized for the knowledgeable care and comfort that we provide to others. It has been said that nurses are the backbone of the healthcare system.  I would suggest that we are that and much more:

Nurses are timeless. Florence Nightingale left the comforts of home care for the sick. Nurses are there for the beginnings and ends of countless lives. We hold the hands of the young, the old, and everyone in between. The shifts are long and if a patient needs us, we work overtime to finish the job. We might wear a uniform, scrubs, a lab coat, or a suit, but we transcend fashion to don whatever our patients need for safe, quality care.

Nurses are trusted. Gallup polls consistently show that the public trusts the ethics and honesty of nurses above even that of physicians, making us one of the most trustworthy professions in the eyes of the people.  Nurses adhere to the ANA Code of Ethics that emphasizes supporting patients’ autonomy and the concepts of beneficence, justice, fidelity, and veracity. All nurses receive education in ethics, with patient care at the center.

Nurses are inspiring.  How many people can say that their jobs changed a life? As a rehabilitation nurse, one woman who had experienced a stroke told me, “I had stroke and died three times. I was in ICU for weeks, but I didn’t feel alive until I came to rehab. Rehabilitation nurses helped me live again!” Yes, transforming lives is what nurses engage in daily. In fact, many of us can name that one nurse that we remember and would choose to have with us if we were sick or dying – that nurse who knows how to inspire and care.

Nurses are experts.  Nurses are expert caregivers, patient advocates, teachers, and researchers. We know the realm of health care better than anyone because we are the licensed professionals who are there 24/7. There are more nurses with advanced practice degrees and certifications than ever before. Nursing has evolved into a discipline with multiple specialties that support best practice in numerous areas that affect health and wellness. Nurses hold positions of leadership in government, the military, organizational systems, health care corporations, and major companies, all attesting to the value of our knowledge and education.

Nurses are still carriers of light. Florence Nightingale was known as “the lady with the lamp”. I always found that image inspiring. One of my favorite memories from my early career occurred while I was working the night shift on a geriatric unit. An elderly man couldn’t get the music he liked to play on the radio, so he asked for someone to sing some old hymns to him. I did so reluctantly at first, holding his hand and singing all the old songs of the faith that I could remember. The next day, I heard him excitedly telling his family members, “An angel came to my room and held my hand and sang to me last night!”  I was puzzled when later he didn’t seem to recognize me as the singing “angel”.  The following night, he died unexpectedly. Reflecting on that experience, I believe that higher powers were at work there. Maybe I was just the vessel through which a bit of healing flowed. Since then, I have seen countless similar examples of extraordinary happenings when caring nurses are involved.

Nurses do more than just enact art and science. Sometimes…our work is like a little piece of heaven.

 

By | 2017-05-16T09:26:36+00:00 May 16th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Nurses Are….

A Mom for all Seasons

I have been fortunate to have a number of mothers in my life – by birth, marriage, or adoption. Each of these women has helped to shape my perspectives and  values in various ways during different seasons of life.  As Mother’s Day approaches, reflecting on the role that mothers play in our lives is a worthy exercise. So, here is my tribute to my mothers.

My first mother is the one who gave me life. I like to think of this as the Spring of my life. Mom Phyllis raised me until the age of 9 years. She tended to the scrapes and cuts, helped to mold my personality, hand-made my clothes, and made life an adventure, all whilst being the wife of a busy doctor who was studying to be a pediatric surgeon. Thank you, Mom, for treasuring my childhood.

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When my parents got divorced, a second mother entered the Summer of my life. Mom Kay took three confused and fragile children under her wings as a young step-mother in her early 20’s. She nurtured us as if we were her own. She helped me navigate the difficult teenage years and transition into young adulthood, listening to countless stories of puppy love, crushed hearts, and future dreams. Mom brought faith and light into a home that had been shattered by divorce. She has given me an example of a loving and faithful wife to my father for 45 years. Thank you, Mom, for preserving my spirit and encouraging my faith in God.

In college, I attended a little Baptist church where they had a program in which families could “adopt” a college student. Through a round-about way, I was adopted by Marvin and Patsy Bell. Grandma Bell, as my children later called her, saw me through my first 17-year  marriage, a painful divorce, and was a second mother to many other young women like me. She has been a faithful friend and mentor for more than 38 years. Ma Bell stood in the place of the mothers who couldn’t be with me during some of the coldest and darkest Winters of life. She attended countless school programs for my kids and never forgets a birthday to this day. Thank you, Ma, for giving me the example of the kind of Grandmother I want to be.

Lastly, when I remarried to my current husband, Jim, I gained a wonderful mother-in-law. Gracie is true to her name. She has a loving and nonjudgmental spirit. She always thinks the best of people and is kind and gentle.  In the Fall of my life, she embraced me as a daughter and is always ready to help in times of need.  Thank you, Mom Mauk, for showing me what unconditional love looks like.

All of us have mothers in our lives that we need to thank. So, this Mother’s Day, purpose to give a special blessing to those women who have so influenced your life. Without them, our days would be less rich and the journey much lonelier. Celebrate those who have traversed the seasons of life with you!

By | 2017-05-14T18:25:19+00:00 May 14th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on A Mom for all Seasons
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