What is the ABCD rule and how does it relate to the appearance of this mole?
BIOL 203 Case Study
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A 60 year old Caucasian female presented to your office with a suspicious mole on her left scapular region. She indicated that her daughter had noticed the mole and had commented that she did not remember seeing such a large mole in that location previously. Her daughter strongly urged her to have the mole looked at by a dermatologist.
The patient relayed that she had spent many hours in the sun without the benefit of a sunscreen for most of her teenage and adult life. She was an avid gardener, and spent many summer weekends boating with her family. She also reported having several severe blistering sunburns when she was a teenager.
Upon examination it was noted that the mole was asymmetrical, slightly raised, with irregular boarders. The color varied from light brown to darker black areas. It measured 8 mm x 10 mm. Additional smaller (~ 2-3 mm), uniformly brown, round moles were noted on her back and legs. The remainder of her skin was unremarkable. Family history was positive for melanoma.
The mole was removed by a full-thickness excisional biopsy. Microscopic analysis of the excised tissue showed proliferation of atypical melanocytes in all levels of the epidermis, with involvement of the papillary dermis.
What is your diagnosis? Justify your diagnosis by relating it to specific signs presented for this patient.
What is the ABCD rule and how does it relate to the appearance of this mole?
What is the significance of the size of the mole?
Describe the structure of the skin, including the epidermal layers, and the dermis.
What is a melanocyte? What is its function?
What is the significance of finding atypical melanocytes in all epidermal layers and in the papillary dermis?
What histological finding suggests that this is not a basal cell or squamous cell carcinoma?
Is there any significance to the history of severe sunburns and this disease? Explain.
Is there any significance to the history of melanoma in the family? Explain.
How would you follow this patient over the next several years?
