Case study

Title Your Name Subject and Section Professor’s Name Date 1 The patient most probably has melanoma Stage IIb. This is based on the American Joint Committee on Cancer (AJCC) 8th edition (T4aN0M0) (Keung & Gershenwald, 2018). By contrast, using a Clark and Breslow staging, this is Clark level 3 and Breslow stage V (Davis et al., 2019). The thickness was only an estimate supported by the study of de-Souza et al. (2019), stating that the epidermis on the back is 150 μm while the dermis differs between their two studies where one study measured it as 1330.6 μm while another gave a 4000 μm measurement. Using the upper limit of the dermis plus the total epidermal thickness, it is around 4.15mm, which is T4a based on AJCC. Also, the patient presented with relatively large, asymmetric, slightly raised nevi with irregular borders and distinct color variation, all malignant features. The suspicion of melanoma is enhanced by the length of exposure to ultraviolet light (UV), particularly during adolescence. Additionally, Zocchi et al. (2021) found a 5 to 10% prevalence of melanoma among those who had another family member with the disease. Another risk factor is the patient's descent (Caucasian), as evidenced by a prevalence of 25 and 60 cases per 100,000 population in Europe and Australia, respectively (Conforti & Zalaudek, 2021). Consequently, the microscopic features of invasive melanoma include increased size (>6mm), the presence of pagetoid melanocytes or those that infiltrate one skin layer to the one beneath it (i.e., epidermis to the dermis), with vertical or radial growth, epidermal ulceration, and scattered positions of junctional melanocytes, all of which are consistent with the patient’s case (Mansour & Donati, 2021). 2 The ABCDE rule refers to asymmetry, irregular borders, uneven color, size greater than 6 mm, and history of evolution (Conforti & Zalaudek, 2021). This patient describes the following: asymmetrical, irregular borders, color variation from brown to black, diameter of 8x10mm, and evolution of mole from a small to a larger size, according to the daughter’s observations. 3 This mole's size correlates with the tumor stage and its ability to metastasize. Larger sizes are linked to a higher stage of melanoma. They may have deeper penetration of the skin layers and thus a higher incidence of metastasis (the spread) to other body organs. From a clinical standpoint, the size of the melanoma usually serves as a determinant for choosing the most appropriate treatment option, and it is also applied as a prognostic factor (Conforti & Zalaudek, 2021; Keung & Gershenwald, 2018). 4 The epidermis and dermis are the main layers of the skin. The fromer has five distinct layers. The topmost layer is the stratum corneum. It is composed of dead skin cells, and serves as the protective layer. This is followed by the stratum lucidum. It is a transparent layer but it is thick in layers that are constantly exposed to mechanical stresses. Underneath this is the stratum granulosum, which consists of granular cells that create keratin, enhancing the skin's strength and making it waterproof. The next layer is the stratum spinosum, which contains desmosomes that anchor the keratinocytes together, forming bonds that resist mechanical stress. The deepest epidermal layer is the stratum basale, which contains cells that are constantly dividing to replace dead skin cells. The new cells arise from here to the most superficial layer (Yousef et al., 2022). By contrast, the dermis has two layers. One of the layers provide nutrition and a means to perceive senses that convey pain. This is the papillary dermis. The deeper layer, the reticular dermis, allows for skin elasticity as it is abundant with collagen and elastin (Yousef et al., 2022). 5 Melanocytes are the pigment-producing cells situated in the basal layer of the epidermis, responsible for producing and distributing melanin, the pigment responsible for skin, hair, and eye coloration, as well as providin...