Introduction
Mr. J is a 42-year-old construction worker who has been diagnosed with malignant melanoma skin cancer. The first symptoms of the condition noticed by the patient included the changes in the size, color, and surface of the mole on the man’s face. In addition, the man reported having the pain in his right shin that could not be relieved with the help of changing a position and that can be associated with metastatic melanoma (Perry, 2019). The purpose of this case study analysis is to discuss the symptoms of malignant melanoma, analyze its normal progression with reference to Mr. J’s case, and describe the prognosis and available treatment.
Skin Changes as the Signs of Malignant Melanoma
The focus on and detection of early warning signs of malignant melanoma are extremely important for patients because this type of cancer develops quickly, and the stage at which the disease is determined is highly significant to affect the outcomes of treatment. In spite of the fact that malignant melanoma can be diagnosed only by a dermatologist or an oncologist with help of testing procedures and using a biopsy, it is possible to determine skin changes that need to be taken into account by patients in order to suspect pathologic alterations (Moran, Silva, Perry, & Gallagher, 2018).
Typical warning signs include changes in the size of pigmented skin lesions, changes in the color of nevi and other pigmented parts, changes in the shape of a lesion, especially when it becomes asymmetric and borders are irregular (Perry, 2019). It is also possible to notice changes in the texture and sensation, as well as effects on the skin near the nevus, including itching, crusting, inflammation, and bleeding. These listed symptoms can be associated with the typical signs of malignant melanoma.
Mr. J has some of the provided signs that are important to pay attention to. Thus, Mr. J’s mole has changed in its size and become larger. Furthermore, it has changed in the color and become darker. Additionally, the texture and the surface of the mole has also altered to become “bumpy,” as it was described by Mr. J. Thus, changes in the appearance of the nevus associated with its growth or inflammation are also typical of malignant melanoma (Perry, 2019). From this perspective, Mr. J has three signs that can be related to malignant melanoma: changes in the size, changes in the color, and changes in the surface. Additionally, the work of Mr. J and his regular exposure to sunlight are critical risk factors for the development of the disease.
Normal Progression of Malignant Melanoma and Its Relation to the Bone Pain
There are five (0-4) specific stages of the development of melanomas. According to the American Joint Committee on Cancer, the staging system includes not only primary stages but also sub-stages in order to determine risks and treatment for a patient in the most accurate way (Perry, 2019). Referring to the normal progression of the condition, Stage 0 is associated with the melanoma remaining in top layers of the skin. At Stage 1, the thickness of melanoma is no more than 2 mm, with or without ulceration. At Stage 2, the melanoma is 1.01-4 mm thick, with or without ulceration, and it is not spread to a person’s lymph nodes or other tissues.
Stage 3 is characterized by the spread of melanoma to the nearest lymph nodes. However, at this stage, cancer is not spread to other organs (Perry, 2019). At Stage 4, the melanoma can spread to other tissues, lungs, brain, bone, and liver, as well as to significantly distant areas of a person’s skin.
Stages 3 and 4 are characterized by the development of metastases, and the spread of cancer to lymph nodes is typical for about 40-60% of patients. Metastases to other organs occur at the final stage of the disease development, and “the most common sites are the lung (18–36%), brain (12–20%), liver (14–20%), and bone (11–17%)” (Perry, 2019, p. 16). Mr. J reported the pain in right shin, and these complaints need to be taken into account as the bone pain can be an indicator of metastases to the bone tissue. According to Gómez-León et al. (2018), bone metastases are usually observed when cancer has affected other tissues and organs, but in some cases, solitary bone metastasis can be observed. Therefore, the bone pain experienced by Mr. J is significant to focus on when determining the stage of malignant melanoma and identifying possible metastases in the patient’s organs.
Treatment and Prognosis for Recovery
The treatment available for Mr. J includes the surgical removal of the mole as the primary therapy. Depending on the stage, the surgical removal of affected lymph nodes is also possible. If the bone pain experienced by the patient is related to metastases, it is also necessary to apply chemotherapy and immunotherapy. The reason is that, in many cases, malignant melanoma cannot be treated only with the help of chemotherapy (Davis, Shalin, & Tackett, 2019).
Recently, chemotherapy has been the only available option for patients after surgery, but today clinicians recommend applying the combination of chemotherapy (based on dabrafenib and vemurafenib) and immunotherapy. Thus, it is possible to use ipilimumab for immunotherapy in patients with melanoma (Perry, 2019). This medication is appropriate to be used in patients with metastatic cancer who have or have not undergone surgical resection.
In cases when advanced melanoma cannot be addressed with the help of the surgical resection of the mole or with the help of traditional chemotherapy, it is also possible to use cytotoxic chemotherapy based on Dacarbazine. From this perspective, in spite of risks associated with the patient’s symptoms and complaints that can be indicative of metastases, Mr. J can receive the treatment appropriate to address his condition (Perry, 2019).
If the pain in bones is not associated with Mr. J’s melanoma, and it is on Stage 0-2, the prognosis for the patient is rather optimistic, and the combination of surgery and chemotherapy can be effective. In the case when Mr. J’s melanoma is metastatic, the focus should be on adding immunotherapy to the treatment plan (Davis et al., 2019). In this case, the prognosis and survival rate significantly depend on the disease stage.
Conclusion
The case of Mr. J’s melanoma has been discussed with reference to warning symptoms of the condition, stages of the disease, and possible treatment options. It is possible to assume that Mr. J’s complaints about the bone pain can be associated with his melanoma. In this case, it is necessary to conduct additional testing for the patient to diagnose metastases in bones. The determination of the stage of melanoma is important to identify the most effective treatment for the patient, as well as the prognosis.
References
Davis, L. E., Shalin, S. C., & Tackett, A. J. (2019). Current state of melanoma diagnosis and treatment. Cancer Biology & Therapy, 20(11), 1366-1379.
Gómez-León, N., Pacheco-Barcia, V., Ballesteros, A. I., Fraga, J., Colomer, R., & Friera, A. (2018). Skeletal muscle and solitary bone metastases from malignant melanoma: Multimodality imaging and oncological outcome. Melanoma Research, 28(6), 562-570.
Moran, B., Silva, R., Perry, A. S., & Gallagher, W. M. (2018). Epigenetics of malignant melanoma. Seminars in Cancer Biology, 51, 80-88.
Perry, M. (2019). Assessing and managing malignant melanoma in primary care. Independent Nurse, 2019(7), 13-16.