Question

Greg Jones, 52 year old male, presents to the doctor’s office today with his wife after mowing the lawn in 100 degree weather this morning. He started to feel dizzy and had just started his new medication for his high blood pressure. When you enter the room you notice he is sunburned, has various freckles and moles scattered over his arms and face. His wife states don’t forget to show the nurse that mole on your back! It did not look like that before. Greg has a history of high blood pressure, diabetes, and high cholesterol. He has a family history of coronary artery disease and skin cancer. Use the ABCDE rule to assess Greg’s mole on his back. Fill out the below documentation and answer the question below.

Answer 1

Skin cancer

Skin cancer begins when normal cell growth goes wrong and disorderly. Overgrowth occurs forming tumors which can be benign or malignant. Benign growths can often be removed, rarely grow back, and do not spread or invade other areas of the body. Malignant growths are more serious than benign growths. They can be removed, sometimes grow back. They can invade and damage nearby tissue and organs, spread/metastasize.

Causes

• chronic exposure to ultraviolet (UV) radiation present in sunlight is responsible for the induction of most nonmelanoma skin cancer (NMSC) in humans.
• Wavelengths in the UV-B (290–320 nm) region of the solar spectrum are absorbed into the skin, producing erythema,burns,and eventually skin cancer.

Pathophysiology

• The first step in UV skin carcinogenesis involves the induction of DNA damage. Occasional mistakes during the repair of this damage leads to the incorporation of wrong bases into the genetic material.
• The DNA damage that is left unrepaired may also disrupt cellular processes by obstructing the DNA and RNA synthesizing machineries and introduce wrong bases into the DNA.
• These types of mistakes often result in mutation leading to loss or inappropriate expression of affected genes.

ABCD Rule of Skin Cancer

The ABCDE Rule of skin cancer is not meant to be a tool for diagnosis but rather one by which individuals and health professionals can differentiate between a problem growth and a simple, everyday blemish.

The ABCDE Rule is broken down as follows:

A for Asymmetry

• Draw a line through the center, you would have two symmetrical halves. In cases of skin cancer, spots will not look the same on both sides. (Shape alone doesn’t suggest a malignancy, since some birthmarks will irregular in shape, but is certainly one of the features when identifying skin cancers.)

B for Border

• Those with a blurry and/or jagged edge can be a sign of a cancerous or pre-cancerous growth.
• The borders of an early melanoma tend to be uneven. The edges may be scalloped or notched.
• A benign mole has smooth, even borders, unlike melanomas

C for Color

• A mole that has more than one color should be considered suspicious.
• Normal moles and spots, by contrast, are usually one color.
• Color changes can include the darkening of a spot (sometimes to dark purple to black) or a lightening in certain parts of the growth.

D for Diameter

• If a growth is larger than a pencil eraser (about 1/4 inch or 6mm), it needs to be checked by a doctor.
• This includes areas of skin that do not have any other abnormalities in terms of color, border, or asymmetry.
• This is not to suggest that smaller growths don't warrant investigation — including skin tags (acrochordons) — but those over 1/4 inches will always be of particular concern.

E for Elevation

• Elevation means that the mole or growth is raised and has an uneven surface. I
• it is both the irregularity of the surface and changes in size that should raise the red flag, particularly if the growth different from any other blemish on the body

• Based on ABCDE rule can diagnose the cancer, either it benign or malignant or it belong to which type of cancer ,
• Basal Cell Cancer- most common on face, sun affected areas, rarely spreads.
• Squamous Cell Cancer -also sun affected areas but many not be sun area, may spread to lymph nodes.
• Melanoma- Lethal type of cancer aminly caused by UV radiation.