Mr. M is a patient whose freckles become worse, and he wants to examine a mole on the back of his neck. Along with information provided by the patient, it seems that he will share such additional subjective data as fatigue, continuous sunlight exposure, and, perhaps, a family history of malignant melanoma (Chang et al., 2014). Mr. M is likely to report that he has the same mole for many years and that he paid no attention to it. Among the required objective data, one should enumerate the examination of the sun-exposed area of the patient’s skin, focusing on asymmetrical lesions, color variegation, and irregular borders (Dunphy, Winland-Brown, Porter, & Thomas, 2015). In this case, it is essential to consider the critical National Guidelines. According to the National Comprehensive Cancer Network (NCCN), every patient with melanoma needs to receive skin examination, dermatologic surveillance, education for self-control, routine imaging, and blood testing (Trotter, Sroa, Winkelmann, Olencki, & Bechtel, 2013). As stated by the American Academy of Dermatology (AAD), it recommends evaluating patients individually, taking into account specific factors affecting their health, anxiety, the ability to recognize melanoma signs, etc.
Following the guidelines elaborated by the American Joint Committee on Cancer, it is appropriate to order computed tomography (TM), skin examination, and biopsy. The combination of the above tests would present the whole picture and determine the level of the disease according to Clark’s system as well as its stage. In addition, one of the key stages in the diagnosis of melanoma is a pathomorphological study. To obtain the material, the tumor needs to be removed, assuming in advance that it can be malignant melanoma, so the excision should be performed widely with the capture of surrounding healthy tissues (Cohen, Bedikian, & Kim, 2013). At the same time, there is a need to refer the given patient to the oncologist for further consultation. The immunohistochemical study would allow not only to determine the diagnosis but also to find out the depth of skin lesions, and the presence of certain mutations in the tumor, which would have a major influence on the choice of tactics for treating the patient.
Medical and nursing diagnoses for Mr. M is malignant melanoma as it is shown by the patient examination – irregular borders, the size of the mole that is more than 6 mm, asymmetry, and biopsy results. Adler, Mahar, and Kelly (2017) mention the following ethical considerations while treating a patient with melanoma: a caregiver’s opinion and potential psychological distress. It is of great importance to be attentive to the given patient and avoid privacy violations. As for legal considerations, there should be no room for professional misconduct or negligence. The medical plan of care would focus on the stage of the disease and may involve lesion excision, radiotherapy, interferon intake, etc. The nursing plan will include patient education based on ABCDE mnemonic and overall support in drug intake and other procedures. Immunization and chemotherapy may be used as complementary therapies.
One should also follow the Healthy People 2020 objective by minimizing the risks of skin cancer (“Skin cancer: Counseling (clinical guide recommendation),” 2017). According to the Circle of Caring, it is possible to suggest that the patient’s family should be involved in the process of treatment and education to ensure optimal recovery. The involvement of the family would allow creating an individualized treatment plan and following it in long-term care. More to the point, a therapist, a nurse, and an oncologist are to work in cooperation.
References
Adler, N. R., Mahar, P. D., & Kelly, J. W. (2017). You should get that mole checked out: Ethical and legal considerations of the unsolicited clinical opinion. Australian Family Physician, 46(12), 949-951.
Chang, C., Murzaku, E. C., Penn, L., Abbasi, N. R., Davis, P. D., Berwick, M., & Polsky, D. (2014). More skin, more sun, more tan, more melanoma. American Journal of Public Health, 104(11), 92-99.
Cohen, P. R., Bedikian, A. Y., & Kim, K. B. (2013). Appearance of new vemurafenib-associated melanocytic nevi on normal-appearing skin: Case series and a review of changing or new pigmented lesions in patients with metastatic malignant melanoma after initiating treatment with vemurafenib. The Journal of Clinical and Aesthetic Dermatology, 6(5), 27-37.
Dunphy, L., Winland-Brown, J., Porter, B., & Thomas, D. (2015). Primary care: The art and science of advanced practice nursing (4th ed). Philadelphia, PA: F.A. Davis Company.
Skin cancer: Counseling (clinical guide recommendation). (2017). Web.
Trotter, S. C., Sroa, N., Winkelmann, R. R., Olencki, T., & Bechtel, M. (2013). A global review of melanoma follow-up guidelines. The Journal of Clinical and Aesthetic Dermatology, 6(9), 18-26.