, 35, is a white, fair-skinned, rural mail carrier. He is married with a 1 year old son. He comes to the clinic for evaluation of a changing lesion…

K.T., 35, is a white, fair-skinned, rural mail carrier. He is married with a 1 year old son. He comes to the clinic for evaluation of a changing lesion on his scalp.

 Subjective data: 

• History of a melanotic lesion on his scalp recently noted to be changing in size and color
• Mother and older brother treated for malignant melanoma in the last 10 years
• Anxious that the lesion might be cancer and require extensive, disfiguring surgery

 Objective Data – Physical Exam:

• Has a 6-mm lesion, lacking in color, scalloped with vaguely defined borders
• Has a large number of small nevi (more than 50) on back, legs, and arms
• Four dysplastic nevi found on back

Objective Data – Diagnostic Studies

• Excisional biopsy confirmed malignant melanoma
• Sentinel node biopsy results were negative
• Diagnostic tests indicate melanoma stage I

 Discussion Questions

1. Identify the categories of the health history that have been addressed and those for which additional data must be obtained.
2. What risk factors for malignant melanoma does he have?
3. What health promotion concepts would you incorporate when performing an assessment of K.T.’s skin?
4. Discuss the developmental (physical, cognitive, psychosocial, behavioral), age, socioeconomic, and cross-cultural considerations that should be considered during the gathering of subjective and objective data and the provision of health care.
5. Relate expected (normal) findings to those described for this patient and discuss any additional information that might be needed before a judgment or diagnosis can be made.
6. Based on the assessment data presented, what are the priority health needs?