Question

Chief Complaint: 48-year-old man with suspicious-looking mole on his back. History: Max Burnell, a single, 48-year-old avid long-distance runner previously in good health, presented to his primary physician for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Max reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Max reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. Max is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically. Physical Examination: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. 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 followng description of the tissue sample: "Diagnosis: Superficial spreading melanoma with vertical level V 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." Discussion Questions: 1. Why was it important to surgically excise and examine this mole? (What type of histological tissue(s) would need to be evaluated for this diagnosis?) 2. What do you think is the official diagnosis for this particular case? (Use the pathology report and sources to support your answer) 3. Which histological structures/cells from Chapter 5 (Histology) would be investigated? (Refer to figures/tables/graphs from the chapter to support your answer) Each individual group member must participate in this discussion by:

Chief Complaint: 48-year-old man with suspicious-looking mole on his back.
History: Max Burnell, a single, 48-year-old avid long-distance runner previously in good health, presented to his primary physician for a yearly physical examination, during which a suspicious-looking mole was noticed on the back of his left arm, just proximal to the elbow. He reported that he has had that mole for several years, but thinks that it may have gotten larger over the past two years. Max reported that he has noticed itchiness in the area of this mole over the past few weeks. He had multiple other moles on his back, arms, and legs, none of which looked suspicious. Upon further questioning, Max reported that his aunt died in her late forties of skin cancer, but he knew no other details about her illness. Max is a computer programmer who spends most of the work week indoors. On weekends, however, he typically goes for a 5-mile run and spends much of his afternoons gardening. He has a light complexion, blonde hair, and reports that he sunburns easily but uses protective sunscreen only sporadically.
Physical Examination: Head, neck, thorax, and abdominal exams were normal, with the exception of a hard, enlarged, non-tender mass felt in the left axillary region. In addition, a 1.6 x 2.8 cm mole was noted on the dorsal upper left arm. 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 followng description of the tissue sample: "Diagnosis: Superficial spreading melanoma with vertical level V 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."
Discussion Questions:
1. Why was it important to surgically excise and examine this mole? (What type of histological tissue(s) would need to be evaluated for this diagnosis?)
2. What do you think is the official diagnosis for this particular case? (Use the pathology report and sources to support your answer)
3. Which histological structures/cells from Chapter 5 (Histology) would be investigated? (Refer to figures/tables/graphs from the chapter to support your answer)
Each individual group member must participate in this discussion by:

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