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Discussion, Nursing, Pages: 1

Lesion Assessment

Lesion Assessment

In order to have a complete review of systems and health history, the patient should be asked more subjective questions about the lesion. In particular, it is essential to inquire whether she observed any asymmetry, changes in border irregularity, change in color or increase in diameter. Whether the lesion scabs, oozes, crusts over or heals and reopens should also be inquired (Ernstmeyer & Christman, 2021): Lesion Assessment.

Considering her age and the history of sun exposure, it would be necessary to clarify her history of skin cancer screening, as well as a family history of melanoma or other skin cancer. At the end of this review, one should also inquire about the degree of her sun protection and how often she performs a full-body skin self-examination or undergoes a professional dermatologic examination.

This patient has several risk factors for skin cancer, particularly non-melanoma skin cancers. The phenotype of her fair skin, a history of severe sun exposure during her teenage years, and a history of solar lentigines make her more prone to UV-induced DNA damage. The fact that she applies sunscreen intermittently and spends a significant amount of time outdoors as a result of her gardening hobby further increases her overall UV exposure.

Also, the presence of a history of squamous cell carcinoma in her mother and the latter reportedly burning easily in the sun adds to the genetic and phenotypic susceptibility (Chattopadhyay et al., 2020). Overall, these risk factors combined put her in the high-risk category of both basal cell carcinoma and squamous cell carcinoma.

The skin has to be thoroughly examined in a well-lit room using the ABCDE rule, which evaluates Asymmetry, Border irregularity, Color variation, Diameter, and Evolution of the lesion (Congdon & Davis, 2023). A dermatoscope may be used to give a magnified image of pigmented structures to aid assessment (Sonthalia & Kaliyadan, 2020). On physical examination, the lesion must be palpated to determine the texture, elevation, bleeding or ulceration.

A punch or shave biopsy should be done based on the findings to perform histopathological analysis. Education to the patient should entail frequent skin examinations, sun protection precautions, and dermatologist referral to ensure continued monitoring. Follow-up will be done depending on the biopsy results, but it should be done within two weeks.

References

Chattopadhyay, S., Zheng, G., Hemminki, A., Försti, A., Sundquist, K., Sundquist, J., & Hemminki, K. (2020). Influence of family history on risk of second primary cancers and survival in patients with squamous cell skin cancer. British Journal of Dermatology, 183(3), 488–494. https://doi.org/10.1111/bjd.18809

Congdon, N. M., & Davis, C. M. (2023). A systematic review of the frequency of features of the seven-point checklist in proven cutaneous melanoma: The importance of change. Skin Health and Disease, 3(6), e295. https://doi.org/10.1002/ski2.295

Ernstmeyer, K., & Christman, E. (2021). Chapter 14 Integumentary assessment. Www.ncbi.nlm.nih.gov; Chippewa Valley Technical College. https://www.ncbi.nlm.nih.gov/books/NBK593218/

Sonthalia, S., & Kaliyadan, F. (2020). Dermoscopy overview and extradiagnostic applications. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537131/

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Question 

Chief Complaint: “I’m here for my routine physical but I have a spot on my back that I’d like the nurse practitioner to look at.”

History of Present Illness: A 61-year-old Caucasian female presents to the community health clinic for a routine physical examination. During the exam, she asks you to look at a “spot” on her back that has been present “for years”. Reports lesion occasionally itches and sometimes bleeds after scratching.

She is unsure if she has noticed a change in the size or color. States it is difficult to visualize due to the location on her back. Not painful or itchy.

What additional (subjective data) questions would you like to ask about her review of systems and health history?

Subjective Data

  • Review of Systems, Past Medical & Social/Family History, and Medications
  • Review of Systems: Denies fever, nausea/vomiting, night sweats, weight loss or weight gains. denies enlarged or painful lymph nodes or red rashes.

Past Medical History:

  • Reports sunbathing as a teenager. Reports she wears sunscreen “sometimes”. Denies tanning bed use. Reports she does sunburn easily and is described as having “fair skin”.
  • Medical History: HTN, Anxiety, Solar Lentigines to bilateral upper extremities
  • Denies tobacco, alcohol, or illicit drug use.
  • Denies any environmental or drug allergies.
  • Current medications: Lisinopril 10 mg daily, Lexapro 10 mg daily
  • Family and Social History: Father MI age 78; Mother alive HTN, CVA, Hx of squamous cell carcinoma; 1 brother age 62, 1 sister age 58, both alive and well
  • Lives with spouse, retired landscape designer; Spends much of her time outdoors; Enjoys gardening and travel
  • States she feels “great” and has no other concerns.

    Lesion Assessment

    Lesion Assessment

Risk Factors and Examination

  • What risk factors does this patient have for skin cancers?
  • Describe techniques of the skin examination and characteristics of the lesion that should be assessed.
Objective Data
Physical Exam Findings:Instructions
In the discussion forum, describe your assessment and plan for this patient including diagnostic testing (if indicated), pharmacological and nonpharmacological treatment (if indicated), health promotion/education, possible referrals, and follow-up.To receive full credit for this discussion:

  • You must post the initial primary post per the due date calendar.
  • You must show evidence of full engagement in the discussion. Posts in discussion on at least three different days. (One day for the primary post and at least two different days for peer responses.)
    Each peer response post demonstrates an analysis of others’ posts and extends the discussion by building on previous posts and asking relevant questions, extends the discussion meaningfully. Evidence/research cited in at least 2 peer posts.
  • The student understands significant ideas relevant to the issue or problem under discussion. This is indicated by the correct use of terminology, a precise selection of the pieces of information required to make a point, correct and appropriate use of examples and counterexamples, demonstrations of which distinctions are important to make, and explanations that are concise and to the point Information and knowledge are accurate The student elaborates statements with accurate explanations, reasons, and evidence Two or more appropriate scholarly sources effectively utilized in the primary post (one source may be a textbook).
  • Writing has no spelling, grammatical, or APA errors, and is organized, clear, and concise. Canvas discussions do not allow for indention for your APA formatting references; instructor is aware.