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1 page/β‰ˆ275 words
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Style:
APA
Subject:
Health, Medicine, Nursing
Type:
Case Study
Language:
English (U.S.)
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Topic:

Clinical Manifestations of Malignant Nodular Melanoma

Case Study Instructions:

History
R.S. is a 38-year-old white male who presents to his PCP after his wife noticed a suspicious-looking, dark brown mole in his scalp while giving him a haircut. He was referred to your clinic. He has a history of lipoma over the left ribcage, surgically removed 10 years ago with no recurrence. He reports an episode of major depression with suicidal tendencies eight years ago, treated successfully with an antidepressant and psychotherapy for 10 weeks with no recurrence.
ROS
No changes in vision, smell, or hearing.
No headaches, cough, fever, chills, night sweats, nausea, or vomiting.
No changes in bowel or bladder habits.
No fatigue or weakness.
SKIN
Fair complexion with multiple scattered nevi on the back.
Negative for rashes and other lesions.
Warm to the touch and slightly diaphoretic.
Normal distribution of body hair.
HEENT
7-mm nodule on the scalp above the right ear, dome-shaped, symmetric, dark brown in color, no variations.
PERRLA.
EOMI.
Funduscopic WNL.
Normal sclera.
TMs intact.
Mucous membranes moist.
Throat without lesions, edema, exudates, or erythema.
Poor dentition, several fractured teeth.
Biopsy
An excisional biopsy of the mole showed cells consistent with that of nodular melanoma. Tumor thickness was 3.8 mm. Cervical nodes were enlarged and measured 2.3 and 2.7 cm. A CT scan of the thorax was negative. With the exception of questionable shadows in the liver, the abdominal CT scan was also negative. A CT scan of the brain was clearly positive for 3 lesions.
Laboratory Blood Test Results
Na = 142 meq/L
Cr = 0.6 mg/dL
WBC = 7,200/mm3
AST = 115 IU/L
K = 4.5 meq/L
RBC = 5.3 million/mm3
ALT = 145 IU/L
Hct = 43%
Glu, fasting = 103 mg/dL
Mg = 2.7 mg/dL
HCO3 = 31 meq/L
Cl = 103 meq/L
Bilirubin, total = 1.7 mg/dL
PO4 = 4.4 mg/dL
Ca = 10.3 mg/dL
BUN = 14 mg/dL
Alb = 3.5 g/dL
Alk phos = 278 IU/L
Plt = 239,000/mm3
Hb = 16.3 g/dL
Questions
Why is the lack of clinical manifestations in the ROS above significant?
Based on this rather limited information provided under History, ROS, SKIN, and HEENT above, which subtype of melanoma is most likely?
Are any of the laboratory blood test results above abnormal and, if so, what is suggested by the abnormality?
What is the current probability that this patient will be alive in 10 years?

Case Study Sample Content Preview:

Discussion Question
Student’s Name
Institutional Affiliation
Discussion Question
1 Why is the lack of clinical manifestations in the ROS above significant?
In this case, there is suspicion of a probable melanoma. The absence of clinical indices in the review of systems is noteworthy. A good prognosis shows that in the case that it was a cancerous growth, there was no spread or metastasis to the other body systems (Claridge, 2017). Therefore, it is manifestations have been ruled out. This is important since it shows that the mole may be a benign growth, or if it is cancerous, its cells have not spread to surrounding tissues, or if they have spread to surrounding tissues, they have not started manifesting symptoms a good prognostic factor.
2 Based on this rather limited information provided under History, ROS, SKIN, and HEENT above, which subtype of melanoma is most likely?
This is a malignant nodular melanoma because of evidence of spread to the liver and cervical lymphadenopathy (Yuksel & Tamer, 2017).
3 Are any of the laboratory blood test results above abnormal, and what is suggested by the abnormality?
Yes, the blood test results obtained from the laboratory are irregular, which include:
* Creatinine of 0.6mg/dl.
The normal range is 0.84 to 1.21 milligrams per deciliter. This means it is low.
The presence of low blood creatinine levels demonstrates lower muscle mass instigated by an illness, such as aging or muscular dystrophy. Conversely, low blood levels might ill...
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