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While considering integumentary disorders, namely, moles, it is essential to pay attention to their size, form, and any recent changes. The evaluation and diagnostics of skin disorders should also be supported by the focus on a patient’s history, occupation, and lifestyle (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). In this case study, Mr. KB is present for the examination as he concerns about his mole that looks different from others.
History and Subjective Assessment
The role of history in assessing patients’ conditions plays a vital role in identifying the differential diagnoses. According to Chang et al. (2014), those who have a family history of skin cancer should be examined at least once a year. Mr. KB reports continuous sunlight exposure and melanoma in his aunt, who was diagnosed at 45. The physical assessment reveals that the identified mole is asymmetrical, prone to color variegation, and tends to have lopsided borders. More to the point, the patient states that he lives in Hawaii, while, previously, he was a construction worker. It is evident that his skin was excessively exposed to the sun. As for the required objective data, Trotter, Sroa, Winkelmann, Olencki, and Bechtel (2013) pinpoint that the National Comprehensive Cancer Network (NCCN) suggests that blood testing, dermatologic surveillance, pathomorphological study, and biopsy are useful to diagnose such patients.
- Malignant melanoma (in situ). This diagnosis is selected as the primary since all the symptoms reported by the patient, as well as physical examination results, coincide with melanoma signs. In particular, the size of 0.2 cm, irregular borders, different colors, verrucous surface, and asymmetry show that this diagnosis is most likely for the given patient. The risk increases with the number of such moles under insolation (Zalaudek et al., 2014). Melanoma has a greater uneven color and may have areas that are red, blue, whitish, or depigmented with the appearance of a scar (Chang et al., 2014).
- Atypical nevi. This disease is characterized by a large size of moles and irregular pigmentation, yet it is not benign (Zalaudek et al., 2014). Nevertheless, such nevi present an increased risk of melanoma development.
- Seborrheic keratoses. It is a category of various non-inflammatory skin diseases characterized by a common symptom such as a violation in the formation of the stratum corneum (Dourmishev, Rusinova, & Botev, 2013). In other words, keratosis causes excessive thickening of the stratum corneum and a delay in normal exfoliation.
- I have pigmented basal cell carcinoma. It has a pearly appearance and telangiectatic blood vessels (Dourmishev et al., 2013).
The choice of treatment method of melanoma depends on the stage of the disease. In situ, treatment is limited to surgical removal of the tumor (Zalaudek et al., 2014). When melanoma spreads on the skin or near the nevus and lymph nodes, adjuvant treatment is also used – after the operation, radiation therapy or biological treatment is performed. Trotter et al. (2013) emphasize that the risk of recurrence of the disease persists for a lifetime; therefore, it is required to visit an oncologist on a regular basis for carrying out control studies. Chang et al. (2014) claim that patients with changing moles should receive basic education on how to recognize melanoma symptoms and determine associated health changes. In order to ensure optimal treatment and recovery, the patient should be referred to an oncologist, who is expected to work in cooperation with nurses and therapists. In addition, it is advantageous to involve the patient’s family members in the long-term treatment and individualized care plan design.
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Chang, C., Murzaku, E. C., Penn, L., Abbasi, N. R., Davis, P. D., Berwick, M., & Polsky, D. (2014). More skin, more sun, more tan, more melanoma. American Journal of Public Health, 104(11), 92-99.
Dourmishev, L. A., Rusinova, D., & Botev, I. (2013). Clinical variants, stages, and management of basal cell carcinoma. Indian Dermatology Online Journal, 4(1), 12-17.
Trotter, S. C., Sroa, N., Winkelmann, R. R., Olencki, T., & Bechtel, M. (2013). A global review of melanoma follow-up guidelines. The Journal of Clinical and Aesthetic Dermatology, 6(9), 18-26.
Zalaudek, I., Cota, C., Ferrara, G., Moscarella, E., Guitera, P., Longo, C.,… Argenziano, G. (2014). Flat pigmented macules on sun-damaged skin of the head/neck: Junctional nevus, atypical lentiginous nevus, or melanoma in situ? Clinics in Dermatology, 32(1), 88-93.