Malignant Melanoma of the Skin Diagnostics and Screening

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Further Questions for the patient

Seborrheic keratosis

When did the mole appear? Or when was it first noticed on the body?
Are the examinations of your body organized by your wife systematic or occasional? If systematic, what are the reasons for them?
How much time do you spend under the sun?
Does the mole itch from time to time?
Are there any other unusual moles on your body?

Malignant melanoma of the skin

Does your family have a cancer history?
Have you ever been treated for cancer? What were the results?
What is the period of mole growth?
Do you observe other changes in your health or mood?
Do you have some skin burns or other changes that are caused by the sun?
Could it happen that your immune system has been weakened recently?

Melanocytic nevi

Have you ever noticed the appearance of new moles?
Do you feel pain or discomfort with the growth of the mole?
Has the color of the mole been changed during the last several days?

Differential Diagnoses

Other seborrheic keratoses (L82.1): is one of the common skin benign tumors that usually affect older males more than 50 years of age (Hiraishi et al., 2013, p. 93). Though chest, face, and shoulders are the most frequent places where this kind of mole could be observed, they could also be found on backs and legs (Longo et al., 2014, p. 121). It is a tan to dark brown neoplasm with a number of clinical appearances that could be caused because of sun exposure (Chang, Wang, Kisner, & Federman, 2012, p. 603). The patient admits that his wife observed a new mole that was different in comparison to all other moles on his back. Besides, it is evident that Jimmy’s skin color is deeply tanned. Sun exposure should be taken into consideration as one of the possible factors that contribute to the development of seborrheic keratosis.

Malignant melanoma of the skin, unspecified (C43.9): is a type of lesion that could be developed in melanocytes (the cells that produce melanin) and introduced as a new pigment that could be different in color (Flaherty, Hodi, & Fisher, 2012, p. 349). In this disease, age turns out to play an important role because a number of unfavorable prognostic variables could be predetermined in older people with the diminished immune system, poor abilities to repair DNA after sun damage, and inabilities to cope with changes in host immune biology (Bartos & Kullova, 2015, p. 143). Jimmy’s main complaint is the inability to understand the nature of a new mole that continues growing and neither looks like other moles on his body nor itches. Such factors as a serious smoking stage and occasional alcoholic drinks could be additional factors to cancer.

Melanocytic nevi, unspecified (D22.9): is a benign growth on the skin that looks like a mole. It is not cancer but a brown or flesh-colored spot on the skin that could grow because of supportive tissue that surrounds the benign (Gulia, Brunasso, & Massone, 2012, p. 443). This change on the skin could be classified into three categories and divided into a number of types with each of them having its own impact on the work of a human body and the development of other diseases such as cancer. Jimmy does not have enough information about the history of the mole or the peculiarities of its development. He wants to clarify the nature of the new mole on his back because he is not so young that some new moles could appear on his body without any reason.

Body Systems to Examine

Seborrheic keratosis, melanoma, and melanocytic nevi are the problems of the skin. Therefore, it is possible to gather the body systems and explain the effects of the differential diagnoses on different systems.

The integumentary system – skin problems and the necessity of surgeries to remove unpleasant moles.

The immune system – stress and poor protection.

The endocrine system – metabolism changes could be observed.

The nervous system – paranoia and the inability to understand the nature of the mole could influence the mental health of a person.

The blood and circulatory system could be affected by cancer because its spread is possible through the bloodstream.

The lymphatic system – cancer cells could approach lymph nodes and begin growing there.

Specific Lab/Testing To Offer

Three differential diagnoses are skin problems. Therefore, the diagnostic steps should be similar to all of them because the nature of the mole could help to clarify the diagnosis and start the required portion of treatment.

Reflectance confocal microscopy (RCM) helps to organize the assessment of skin neoplasms at the cellular level in a short period of time (Ahlgrimm-Siess et al., 2013, p. 120).

A biopsy helps to examine the tissue that could be taken from the body in case it is abnormal to check if cancer is the reason for the mole or not (Chang et al., 2012, p. 603).

Dermoscopy aims at examining the skin with the help of special skin surface microscopy and defining the nature of skin lesions (Gulia, Brunasso, & Massone, 2012, p. 450).

References

Ahlgrimm-Siess, V., Cao, T., Oliviero, M., Laimer, M., Hofmann-Wellenhof, R., Rabinovitz, H. S., & Scope, A. (2013). Seborrheic keratosis: reflectance confocal microscopy features and correlation with dermoscopy. Journal of the American Academy of Dermatology, 69(1), 120-126

Bartos, V. & Kullova, M. (2015). Age-related differences in the incidence and clinicopathological findings of malignant melanoma of the skin. Our Dermatologist Online, 6(2), 140-144.

Chang, C.R., Wang, S., Kisner, R., & Federman, D.G. (2012). Elderly adults and skin disorders. Southern Medical Journal, 105(11), 600-606.

Flaherty, K. T., Hodi, F. S., & Fisher, D. E. (2012). From genes to drugs: Targeted strategies for melanoma. Nature Reviews Cancer, 12(5), 349-361.

Gulia, A., Brunasso, A.M.G., & Massone, C. (2012). Dermoscopy: Distinguishing malignant tumors from bening. Expert Review of Dermotology, 7(5), 439-458.

Hiraishi, Y., Hirobe, S., Iioka, H., Quan, Y. S., Kamiyama, F., Asada, H.,… & Nakagawa, S. (2013). Development of a novel therapeutic approach using a retinoic acid-loaded microneedle patch for seborrheic keratosis treatment and safety study in humans. Journal of Controlled Release, 171(2), 93-103.

Longo, C., Moscarella, E., Piana, S., Lallas, A., Carrera, C., Pellacani, G.,… & Argenziano, G. (2014). Not all lesions with a verrucous surface are seborrheic keratoses. Journal of the American Academy of Dermatology, 70(6), e121-e123.