CASE STUDY ASSIGNMENT CHAPTER 47
The patient is a 25-year-old male with a past medical history of obesity and thyroid disease. He recently noticed that a mole on his face seemed to be getting larger and darker. At first he did not worry because he was in the sun a great deal and assumed the change may have been caused by sunburn. After a month, not only was the mole larger and darker, but it appeared to be “bumpy.” He saw the nurse practitioner and was diagnosed a malignant melanoma skin cancer following biopsy of the nevus. The patient is now reporting pain in his right shin that does not go away when he puts his feet up or sleeps.
Additionally he has a moist, red, vesicular rash on his cheeks and on the back of his arms. He reports that he has had this since he was a child and assumed it was hereditary because his Mom had a similar rash. He does state that it ” has gotten worse and is more itchy that usual”.
1. Relate the patient’s skin changes to the warning signs for malignant melanoma. Be thorough.
2. Discuss the normal progression of this malignancy. What is the significance of the bone pain that the patient is experiencing now?
3. Review atopic dermatitis and discuss the pathophysiology of the patient’s symptoms. What other conditions may be seen in conjunction with atopic dermatitis? Explain.
Case Study Assignment: Chapter 47
Question 1
The patient had several warning signs of a malignant melanoma. One of the is the presence of a mole that has been changing its characteristics. A characteristic of a malignant melanoma is a mole that increases in size and changes its color over time (Balch et al., 2020). The other warning sign is the presence of red, moist, vesicular rash on his cheeks and back of his arms that has been there since childhood. His mother also had similar rash. The rash has been itchy than usual, hence, the warning sign.
Question 2
The malignant melanoma progresses in five stages, stages 0 to 5. In stage 0 melanoma, the melanoma has not spread to other parts of the body and is within the epidermis. It has no affected the surrounding lymph nodes. In stage I, the tumor diameter is not more than 2mm thick and has not spread to the surrounding lymph nodes or distant body parts. In stage II, the tumor size is more than 1 mm thick, may be ulcerated, and has not spread to surrounding lymph nodes and other body parts. In stage III, the tumor is more than 1 mm, has spread to the surrounding lymph nodes, and has not spread to distant body parts. In stage IV, the tumor is of any thickness, may or not be ulcerated, spread to distant lymph nodes and body parts (Balch et al., 2020).
Question 3
Atopic dermatitis is a disorder of the skin that develops from dysfunction in skin barrier, alterations in the immune responses, hyper-response to environmental influences, and IgE mediated hypersensitivity. The patient is experiencing worsening itchiness on the rash due to skin hypersensitivity to IgE mediated responses. The patient experiences unregulated cancerous cell division due to altered cell mediated immune system and skin barrier dysfunction. The other conditions that may be seen in conjunction with atopic dermatitis include allergic reactions, skin infection, impetigo, alopecia, ichthyosis vulgaris, and vitiligo(McCance & Huether, 2018). These conditions develop due to altered skin barrier, microbiome, and immune dysfunction.
References
Balch, C. M., Atkins, M. B., Garbe, C., Gershenwald, J. E., Halpern, A. C., Kirkwood, J. M., McArthur, G. A., Thompson, J. F., & Sober, A. J. (2020). Cutaneous Melanoma. Springer International Publishing.
McCance, K. L., & Huether, S. E. (2018). Pathophysiology Online for Pathophysiology (Access Code and Textbook Package): The Biologic Basis for Disease in Adults and Children. Elsevier – Health Sciences Division.