26 Aug 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.

D1. History

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

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 questionable 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

HCO3 = 31 meq/L

Cl = 103 meq/L

Bilirubin, total = 1.7 mg/dL

PO4 = 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

Questions

Answer all questions.

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?

D2. Assessment Description

Answer both of the following questions for your discussion response.

What is the pathological process in the development and presentation of eczema versus psoriasis?

Discuss the pathological process and presentation of atopic dermatitis and its relationship to asthma and allergies.

D3. Assessment Description

Select two of the following questions for your discussion response.

1.Review the hypothalamus, pituitary, and ovarian axis, and explain the pathophysiology of PCOS. Explain the role of hormones in the development of this disorder. How does PCOS contribute to infertility?

2.Explain the role of genetics and oncogenes in the development of reproductive cancers. In addition, examine if genetically linked reproductive cancers are only seen in women or are they also in men?3.

3.Jones, a 60-year-old male, was seen for his yearly physical. Upon review of his lab results, a high PSA level was seen. Having heard about the PSA test and correlation to prostate cancer, he is worried about a diagnosis of cancer. What would you tell Mr. Jones in your discussion about the lab results?

D4. Assessment Description

Select two of the following questions for your discussion response.

1.Explain the pathophysiological development of breast cancer. Detail the varying types and oncogenic influences for each type.

2.Menopause comes at different ages for women. What are the changes causing menopause and what are the changes experienced after menopause?

3.Testicular cancer is common in younger men. Upon examination, you discover a hard nodule of the right testes. What are the oncogenic influences associated with testicular cancer?

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