Skin cancer is the most diagnosed of all cancers combined (American Cancer Society, 2022). It is estimated that 5.4 million basal and squamous cell cancers are diagnosed each year in about 3.3 million Americans and at least 20% of people will develop skin cancer by the age of 70. These numbers have been increasing for many years and are expected to continue to increase due to better skin cancer detection, increased sun exposure, and longer life expectancy (American Cancer Society, 2022).

Skin cancers typically begin in the top layer of the skin (epidermis) and are largely due to sun exposure. There are two main types of skin cancer: melanoma and nonmelanoma. Nonmelanoma, which can be further divided into basal cell and squamous cell cancer, is the most diagnosed, but does not typically result in death. Melanoma, although much less common than nonmelanoma skin cancer and only accounting for about 1% of skin cancers, causes a large majority of skin cancer deaths (American Cancer Society, 2022).

There are many risk factors for developing skin cancer. Exposure to ultraviolet rays is related to 90% of all cutaneous melanomas (Melanoma Research Foundation, 2022). Additionally, light-colored skin, increasing age, male gender, weakened immune system, and history of skin cancer are major risk factors for both nonmelanoma and melanoma skin cancers (American Cancer Society, 2019a). Exposure to certain chemicals and radiation, severe skin inflammation, psoriasis treatment, human papillomavirus infection, and smoking are also risk factors for nonmelanoma skin cancers. Risk factors unique to developing melanoma include having many moles and/or irregular moles (American Cancer Society, 2022). Keep in mind that people of color can also get skin cancer, with lesions often occurring in parts of the body that get little sun such as soles of the feet and lower extremities (American Academy of Dermatology Association, 2022a).

Reducing exposure to ultraviolet rays through photoprotective behaviors has the strongest link to skin cancer prevention. Home healthcare clinicians routinely assess skin for wounds, skin changes, or suspicious skin lesions. This is an important area that should be incorporated into the start of care with ongoing reassessment. It is important to educate individuals about the importance of skin self-examination and make referrals when suspicious lesions are identified. Regular skin self-exam is an important step in detecting skin cancer at its earliest stages. The American Academy of Dermatology Association developed the ABCDEs of Melanoma as a screening tool. The acronym stands for Asymmetrical shape, Border, Color, Diameter, and Evolution. Asymmetrical shape refers to irregular shape, as benign moles are usually symmetrical. Noncancerous moles typically have smooth, even borders, whereas melanoma lesions have irregular borders that are difficult to define. Color variation in skin mole (blue, black, brown, tan, etc.) or uneven distribution of color can be an indicator of a melanoma lesion, in addition to a diameter greater than 6 mm. Lastly, the most important factor to observe for is evolution (change) in the mole. For a visual representation of the ABCDEs of skin assessment, see https://www.aad.org/public/diseases/skin-cancer/find/at-risk/abcdes (American Academy of Dermatology Association, 2022b).

A review of systems is an essential component of assessment for home healthcare clinicians. Included in this review of systems is examining the integumentary system, as well as obtaining past medical history such as a history of cancer in the individual or family members. The Centers for Disease Control and Prevention has not concluded there is enough evidence to recommend for or against routine screening for skin cancer. However, the American Cancer Society continues to recommend that people complete routine self-screenings at least once a month (Dundas, 2020). Therefore, performing screening of the integumentary system, obtaining past medical history, and providing targeted education at the start of care are important aspects of a clinician's assessment and intervention (Dundas, 2020). When providing patients with instruction on skin self-exam, direct them to use a well-lit room with a full-length mirror. Important areas to examine include the face, ears, neck, chest, belly, underarms, hands and fingers, thighs, feet and toes, buttocks, back, and scalp (American Cancer Society, 2019b). Utilizing a hand mirror, or asking a spouse, partner, or caregiver for assistance are good ways to ensure that all areas of the body are fully examined to the best of their ability. If abnormalities are noted during screening, individuals should contact their primary care provider or dermatologist for a follow-up examination (Dundas, 2020).

Education about routine self-screening for skin cancer, supplying resources for patients if a referral is required, and reinforcing photoprotective behaviors are interventions that home healthcare providers should implement in their practice to mitigate unnecessary delays in cancer detection for patients. Skin cancer is a significant burden within the United States, and through taking a thorough patient history, and providing patient education on the ABCDEs of mole assessment, home healthcare clinicians can play an integral part of preventative care as it relates to skin cancer.

COVID-19 was third leading cause of death in the United States in both 2020 and 2021

NIH: COVID-19 was the third leading cause of death in the United States between March 2020 and October 2021, according to an analysis of national death certificate data by researchers at the National Cancer Institute. During the 20-month period studied, COVID-19 accounted for 1 in 8 deaths (or 350,000 deaths) in the United States. In every age group 15 years and older, COVID-19 was one of the top five causes of death during this period. The pandemic has also had an indirect effect on other causes of death in the United States. Past data show deaths from other causes, including heart disease, accidents, stroke, Alzheimer's disease, and diabetes increased from 2019 to 2020, possibly because people were reluctant to seek medical care for fear of catching COVID-19.

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