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R.S., a 38-year-old male, presented with a dark brown mole on his scalp, which was biopsied and diagnosed as nodular melanoma with a tumor thickness of 3.8 mm. Imaging revealed enlarged cervical nodes and three lesions in the brain, while laboratory tests indicated elevated liver enzymes. The document also poses questions regarding the significance of clinical manifestations, melanoma subtype, abnormal lab results, and the patient's 10-year survival probability, as well as discussing eczema, psoriasis, and atopic dermatitis.

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21 views2 pages

Text

R.S., a 38-year-old male, presented with a dark brown mole on his scalp, which was biopsied and diagnosed as nodular melanoma with a tumor thickness of 3.8 mm. Imaging revealed enlarged cervical nodes and three lesions in the brain, while laboratory tests indicated elevated liver enzymes. The document also poses questions regarding the significance of clinical manifestations, melanoma subtype, abnormal lab results, and the patient's 10-year survival probability, as well as discussing eczema, psoriasis, and atopic dermatitis.

Uploaded by

lavarielewis
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as TXT, PDF, TXT or read online on Scribd

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 8 years ago, treated successfully with an
antidepressant and psychotherapy for 10 weeks with no recurrence.

Review of Systems (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 ques
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
• HC03 = 31 meq/L
• Cl = 103 meq/L
• Bilirubin, total = 1.7 mg/dL
• P04 = 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

1. Why is the lack of clinical manifestations in the ROS above significant?


2. Based on this rather limited information provided under History, ROS, SKIN, and
HEENT above, which subtype of melanoma is most likely?
3. Are any of the laboratory blood test results above abnormal and, if so, what is
suggested by the abnormality?
4. What is the current probability that this patient will be alive in 10 years?

1. What is the pathological process in the development and presentation of


eczema versus psoriasis?
2. Discuss the pathological process and presentation of atopic dermatitis
and its relationship to asthma and allergies.

Appropriate demographic factors such as age, gender, and ethnicity for individuals
with Chrohn’s Disease.


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