What patient teaching would you offer to patients about extensive exposure to sunlight?

Real-Life Challenge: Malignant Melanoma

A 35-year-old, fair-skinned woman has noticed the enlargement of a mole on her right lower arm. The mole has been present as long as she can remember. In the past month, it appears to have doubled in size and has become darker. The patient admits to having been exposed to direct sunlight for the past several years. She lives in southern Texas and spends several hours a day in the sun while doing garden work. She has not consistently applied sunscreen to her lower arms and hands. Visual examination shows a slightly elevated, 7-mm, irregularly-shaped, dark multicolored lesion on the dorsal aspect of the right lower arm, about 3 inches above the wrist. Closer examination shows the lesion to be asymmetrical with a notched border. Family history reveals that the patient’s mother had three lesions removed from her arms and face that were diagnosed as malignant melanoma. In addition, two maternal aunts have had malignant melanomas. One aunt recently died from metastatic cancer. The patient remembers having incurred several sunburns with blistering as a child. Surgical excision of the lesion is performed, and the biopsy confirms the diagnosis of malignant melanoma. The patient is referred to an oncologist for possible chemotherapy.

Questions:

1. What characteristics does the patient have that suggest she may have malignant melanoma?

2. What symptoms distinguish malignant melanoma from basal cell or squamous cell carcinomas?

3. What is the prognosis for a patient with malignant melanoma, such as this patient?

4. What patient teaching would you offer to patients about extensive exposure to sunlight?

5. What is the importance of a good family history?

6. Why was the patient referred to an oncologist?

7. Would this patient be a candidate for further surgical procedures? If so, what procedures and why?

8. List the warning signs of malignant melanoma.

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