Scenario: 61-year-old Caucasian female presents to the community health clinic for a routine physical examination. During the exam, she asks you to look at a “spot” on her back that has been present “for years”.
What additional questions would you like to ask about her health history?
Additional History and Home Medications:
Reports lesion occasionally itches and sometimes bleeds after scratching. She is unsure if she has noticed a change in the size or color. States it is difficult to visualize due to the location on her back.
Reports sunbathing as a teenager. Reports she wears sunscreen “sometimes”. Denies tanning bed use. Reports she does sunburn easily and is described as having “fair skin”.
Past Medical History: HTN, Anxiety, Solar Lentigines to bilateral upper extremities
Denies tobacco, alcohol, or illicit drug use.
Denies any environmental or drug allergies.
Current medications: Lisinopril 10 mg daily, Lexapro 10 mg daily
Family and Social History: Father MI age 78; Mother alive HTN, CVA, Hx of squamous cell carcinoma; 1 brother age 62, 1 sister age 58, both alive and well
Lives with spouse, retired landscape designer; Spends much of her time outdoors; Enjoys gardening and travel
States she feels “great” and has no other concerns.
- What risk factors does this patient have for skin cancers?
- Describe techniques of the skin examination and characteristics of the lesion that should be assessed.
- Discuss your assessment and plan for this patient including diagnostic testing (if indicated), pharmacological and nonpharmacological treatment (if indicated), health promotion/education, possible referrals, and follow-up.
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