Question
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Physical Examination
Head, neck, thorax, and abdominal exams were normal, apart from a hard, enlarged, non-tender
mass felt in the left axillary region. In addition, a mole was noted on the left
posterior thoracic region. The lesion had an appearance suggestive of a melanoma. It was
surgically excised with 3 mm margins using a local anesthetic and sent to the pathology
laboratory for histologic analysis.
Pathology Report
The pathology report gave the following description of the tissue sample:
“Diagnosis: Superficial spreading melanoma with vertical level invasion. Coalescent nests of
neoplastic cells were noted in the papillary and reticular dermis and in the subcutaneous layer.
In addition, large, pink-stained cells with pleomorphic nuclei were found spreading radially
through the epidermal layer. Proliferating lymphocytic cells are noted in the dermis surrounding
the malignant cells.”
Follow-Up
Hannah is told that she has malignant melanoma and that it may have already metastasized.
She is advised that she may need additional surgery to verify that this tumor has metastasized.

Ask by Parry Bob. in the United States
Jan 20,2025

Upstudy AI Solution

Tutor-Verified Answer

Answer

Hannah has been diagnosed with malignant melanoma, a type of skin cancer. A hard mass was found in her left armpit, and a mole on her back was surgically removed and confirmed to be melanoma. The pathology report shows that the cancer has invaded deep into the skin layers and may have spread to nearby lymph nodes. She may need additional surgery to check for metastasis and further treatment as advised by her doctor.

Solution

The provided information outlines a clinical case involving a patient named Hannah who has been diagnosed with malignant melanoma. Let’s break down the key points and implications of this case step by step.

Known Conditions

  1. Physical Examination Findings:
    • Normal head, neck, thorax, and abdominal exams.
    • A hard, enlarged, non-tender mass in the left axillary region.
    • A mole on the left posterior thoracic region measuring with characteristics suggestive of melanoma.
  2. Pathology Report Findings:
    • Diagnosis: Superficial spreading melanoma with vertical level invasion.
    • Presence of neoplastic cells in the papillary and reticular dermis and subcutaneous layer.
    • Large, pink-stained cells with pleomorphic nuclei spreading radially through the epidermis.
    • Proliferating lymphocytic cells in the dermis surrounding malignant cells.
  3. Follow-Up Recommendations:
    • Hannah has been informed of the malignant melanoma diagnosis and the possibility of metastasis.
    • Additional surgery may be required to confirm metastasis.

Step-by-Step Analysis

  1. Understanding Melanoma:
    • Melanoma is a type of skin cancer that arises from melanocytes, the cells that produce pigment in the skin.
    • The “superficial spreading” type is the most common form of melanoma and is characterized by horizontal growth before it invades deeper layers.
  2. Vertical Level Invasion:
    • The vertical level of invasion indicates that the melanoma has penetrated deeply into the skin layers, which is associated with a higher risk of metastasis.
    • Level signifies that the melanoma has invaded the subcutaneous tissue, which is concerning for potential spread to other parts of the body.
  3. Histological Findings:
    • The presence of neoplastic cells in various skin layers suggests aggressive behavior of the melanoma.
    • The description of pleomorphic nuclei indicates that the cancer cells are abnormal and may be rapidly dividing.
    • The presence of lymphocytic cells suggests an immune response to the tumor, which can be a positive sign, but it also indicates that the body is recognizing the malignancy.
  4. Implications of Metastasis:
    • The enlarged mass in the axillary region could represent a lymph node that has been affected by the melanoma.
    • If metastasis is confirmed, it may require more extensive treatment, including possible lymph node dissection and systemic therapies.
  5. Next Steps:
    • Additional imaging studies (e.g., CT scans, PET scans) may be necessary to assess for distant metastasis.
    • Surgical excision of the primary melanoma with clear margins is crucial.
    • Follow-up with an oncologist for potential adjuvant therapy (e.g., immunotherapy, targeted therapy) may be indicated based on the stage of the disease.

Conclusion

Hannah’s case of malignant melanoma is serious due to the vertical invasion and potential for metastasis. Close monitoring and further surgical intervention are essential to manage her condition effectively. It is important for her to discuss all available treatment options with her healthcare team to ensure the best possible outcome.

Answered by UpStudy AI and reviewed by a Professional Tutor

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Beyond the Answer

Melanoma, an aggressive form of skin cancer, has a historical significance dating back to ancient civilizations where skin observations were first documented. The term “melanoma” was coined in the early 19th century, but it wasn’t until the mid-20th century that its connection to sun exposure and UV radiation was established. This connection has led to heightened awareness and preventive measures like sunscreen use and skin checks, dramatically improving early diagnosis and treatment outcomes!
For anyone facing a diagnosis like Hannah’s, it’s crucial to navigate follow-up steps effectively. Common pitfalls include underestimating the importance of lymph node evaluations since metastasis often involves these nodes. Additionally, staying informed about emerging treatments (like immunotherapies and targeted therapies) can empower patients in their own care journey. Engaging with a healthcare team that specializes in melanoma is essential, as they will know the best paths to take for further evaluation and treatment options!

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