Question

Donald smith is a 37 year old white , fair skinned, blue eyed park ranger who enjoys fishing and skiing. He comes to the clinic for evaluation of a changing mole.

subjective data
*History of a mole on his left cheek from birth that has become hard, scaly and lumpy over the last 3 months
* father and sister treated for malignant melanoma in the last 10 years
* Anxious that the mole might be cancer and require surgery

objective data

* Has a 6mm nevus blue black in color, scalloped with vaguely defined borders
* Two dysplastic nevi found on neck

diagnostic studies

1. what risk factors for malignant melanoma does this client have ?
2. what is the prognosis with this stage of malignant melanoma?
3. what would the nurse include in a patient teaching plan to address further sun exposure to this patient?
4. what is the priority of care for this client?

Answer 1

Malignant Melanoma

It is the most deadly of all skin cancers.

1.Risk factors for Malignant melanoma this client has are:

1.Single most important risk factor is exposure to excessive sunlight ( uva and uvb) at an early age

2.Dysplastic nevus syndrome

3.History of melanoma in first or second degree relative

4.History of family member with melanoma.

2.staging can be done as:

A. Breslows method: it measures the vertical distance in mm from granular cell layer to deepest part of timor by using a microscopic micrometer. They use breslows thickness in another staging system for melanoma called TNM staging

As per this:

T1a: means melanoma is less than 0.8 mm thick and skin over tumor does not look broken under microscope

N0 and M0

Thus it is stage 1a.

Prognosis in malignant melanoma is best corelated by depth of invasion.

Prognosis of stage 1 : It is highly curable. Low risk of recurrence. 5 year survival rate is 98%.

3.Advise patient to wear protective clothes.

Advise patient to avoid going out during the time 10am to 3 pm during which Sundays are strongest.

Advise to use sunlotion when going outdoor. Sunscreen of SPF of 15 to 30 will block most of sun's harmful rays

Self skin assessment periodically.

Any changes in the mole has to be assessed and properly treated.

4.This patient has to stop going out to sunlight.

This patient is treated as: Excision of the mole with 1 cm margin.

Sentinal lymph nodes biopsy may be needed in some patients. If no cancer cells found here then no further treatment is needed. If cancer cells found in biopsy then lymph nodes dissection to be done.