A persistent or recurrent reddened and roughened area that scales. It is caused by prolonged exposure to ultraviolet radiation
The Skin which covers the entire body is the largest organ of the body accounting for 20% of the body weight. The primary function of the skin is to protect the body from the external environment by serving as a barrier against micro organisms, ultraviolet radiation, loss of body fluids and the stress of mechanical forces.(Huether & McCance, 2017). In Case 2, K.B. is a 52 year Caucasian who subjectively presented with a history of skin moles for the past 2 years but he is currently concerned because the mole is changing colors, which is new because other moles remain the same in color, thus the reason for his visit. K.B has a history of frequent visits to the tanning bed and works as a construction worker in Hawaii. Objective assessment indicated that the mole has an irregular borders, round, scaly, dark in color unlike the rest and it is 0.2 cm in size. Differential diagnosis: Malignant melanoma: It is the most serious skin. In 2015, 73,870 new cases and 9,940 deaths were reported in the United States. Risk factors include personal or family history, ultra violet radiation(UVR) exposure, including sun bed use before age 30 years, fair hair, light skin with repeated sunburns, freckles, geographical location, younger females and older males. (Iannino-Renz, 2018).K.B.’s history’ physical and geographical location puts him at risk for Malignant melanoma. Skin lesions that present with characteristics such as asymmetry, borders, color, diameter and evolution (ABCDE),may indicate a skin condition such as malignant melanoma(Ball et al. 2015). K.B’s lesion presented with dark color, a symmetry that was different from the others, border was irregular and a diameter of 0.2 cm which is greater than 6 mm. The dark color and the irregular borders of the mole as well as the size is very significant in this differential diagnosis. K.B should be concerned because all these characteristics indicates that the mole is most likely a malignant melanoma Seborrheic Keratosis: This is a benign proliferation of cutaneous basal cell tissue that may produce flat or slightly elevated lesions which are dark brown-black colors but varies from a few millimeters to several centimeters in diameter and oval in shape. (Battura et al.(2017).They often occur in older people with multiple lesions. Actinic keratosis: A persistent or recurrent reddened and roughened area that scales. It is caused by prolonged exposure to ultraviolet radiation. (Battura et al. 2017).The lesions appear as poorly defined papules which may be felt more than seen. Treatment Options: Surgical excision of primary lesion site, radiation therapy, chemotherapy and immunotherapy are some of the options available for treatment. For standard treatment of low risk malignant melanoma, cryosurgery using liquid nitrogen is preferred. this option is useful for patients who cannot hold anticoagulants and the procedure can be done in the office without anesthesia.(Iannino-Renz, R, 2018). Another treatment option is the curettage and electrodessication with topical anesthesia. Surgical incision is recommended for lesions with questionable borders.(Iannino-Renz, R. 2018) . References: Ball, J.W., Dains, J.E., Flynn, J.A., Solomon, B.S., Stewart, R.W. (2015). Seidel’s Guide to Physical Examination.(8th ed.) St. Louis, MO: Elsevier. Buttaro, T.M., Trybulski,J., Polgar-Bailey, P., Sandberg-Cook, J. (2017). Primary Care: A collaborative Practice (5th ed.) St. Louis, MO: Elsevier. Huether, S.E., McCance, K.L.(2017). Understanding Pathophysiology. (6th ed.) St. Louis, MO: Elsevier Iannino-Renz, R. (2018). Malignant Melanoma: How Could This Be Me? Medsurg Nursing. 27(4) 251-256
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