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Patients’ history and previous experiences can inform nurses’ diagnosing process. For example, in examining skin conditions, skin color can play a significant role. Another important factor is one’s exposure to the sun and their use of sunscreen (Buttaro, Trybulski, Polgar Bailey, & Sandberg-Cook, 2017). In the discussed case (2), the patient, K.B., is a 52-year-old Irish-American male who presents to the office with a mole that was in place for almost two years but raised his concerns recently.
The lesion is revealed to be round but with an irregular border. It is approximately 2 mm in size, and it is scaly dark in color. For K.B., it is vital to determine whether this lesion is benign or malignant to provide the most suitable treatment. The primary diagnosis for the described shape is melanoma, while differential diagnoses include dysplastic nevi, basal cell carcinoma, and actinic keratosis.
Primary Diagnosis
The patient’s history and examination suggest the diagnosis of melanoma. It is a malignant condition that can affect various areas of one’s body. In determining abnormalities of the skin, one can utilize the ABCDE scheme (Tsao et al., 2015). First of all, the lesion is not very asymmetrical but round in shape. However, it has irregular borders which are characteristic of melanomas (Tsao et al., 2015). The lesion’s distribution of color is not uneven, but it has different dark shades.
The diameter of the shape much less than 6 mm, signifying an early-detected melanoma or a benign dysplastic nevus (Tsao et al., 2015). The final characteristic is the process of evolving – if the lesion changed shape or color during the previous years, it is likely to be malignant. The patient’s light skin color is a risk for developing melanomas (Buttaro et al., 2017). Moreover, frequent exposure to the sun without any protection increases the danger of malignant growth.
Differential Diagnosis
- The first differential diagnosis is a dysplastic nevus. These benign moles are similar in appearance to melanomas, having irregular borders, a large size, and uneven color (Mitsui et al., 2016). They can also mean that a person is at risk of developing skin cancer.
- The second potential condition is basal cell carcinoma – a round nodule with a shiny surface and ulceration (Reiter et al., 2018). The patient’s lesion has irregular borders and is scaly, which does not correspond with the typical description of basal cell carcinoma.
- The final differential diagnosis is actinidic keratosis, growth with the potential to become malignant. It is scaly and otherwise asymptomatic, but it appears old older people with light skin and high levels of sun exposure (Werner et al., 2015). The patient’s lesion is dark and round, and scaling is not as visible as it is in examples of actinidic keratosis. K.B. should undergo a biopsy to confirm the diagnosis.
Treatment Options
After establishing that K.B. has melanoma, the lesion can be removed surgically to prevent future spreading. If it is at its early stage, the melanoma will be easy to remove, and it will not damage other tissues (Buttaro et al., 2017). However, if it is determined that melanoma has spread beyond the skin, other options should be reviewed, such as additional surgery or therapy (chemotherapy, radiation, or medication).
Conclusion
Skin cancer is a risk for older adults who spent much of their time under the sun without sufficient protection. It is especially dangerous for people with light skin, and they should always pay attention to their moles and lesions. In the discussed case, the patient presents to the office with a shape that, according to ABDCE guidelines, adheres to the description of malignant melanoma. Other diagnoses are a dysplastic nevus, basal cell carcinoma, and actinic keratosis. A biopsy is necessary for confirming the diagnosis, followed by surgery to remove the lesion.
References
Buttaro, T. M., Trybulski, J., Polgar Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaborative practice (5th ed.). St. Louis, MO: Elsevier.
Mitsui, H., Kiecker, F., Shemer, A., Cannizzaro, M. V., Wang, C. Q., Gulati, N.,… Cueto, I. (2016). Discrimination of dysplastic nevi from common melanocytic nevi by cellular and molecular criteria. Journal of Investigative Dermatology, 136(10), 2030-2040.
Reiter, O., Mimouni, I., Gdalevich, M., Marghoob, A., Levi, A., Hodak, E., & Leshem, Y. A. (2018). The diagnostic accuracy of dermoscopy for basal cell carcinoma: A systematic review and meta-analysis. Journal of the American Academy of Dermatology. Web.
Tsao, H., Olazagasti, J. M., Cordoro, K. M., Brewer, J. D., Taylor, S. C., Bordeaux, J. S.,… Begolka, W. S. (2015). Early detection of melanoma: Reviewing the ABCDEs. Journal of the American Academy of Dermatology, 72(4), 717-723.
Werner, R. N., Stockfleth, E., Connolly, S. M., Correia, O., Erdmann, R., Foley, P.,… Martin, G. (2015). Evidence‐and consensus‐based (S3) guidelines for the treatment of actinic keratosis–International League of Dermatological Societies in cooperation with the European Dermatology Forum–short version. Journal of the European Academy of Dermatology and Venereology, 29(11), 2069-2079.
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