Skin & Subcutaneous Tissue


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M64_F1.jpg"}},{"insert":"\n\n"},{"insert":"You sit back, feeling drained.\n\nAn incessant procession of patients has passed through your door over the last several hours, and you find yourself hoping that the dermatology clinic will end soon.\n\n\u0022This is the last patient, doctor\u0022, your nurse urges you. You nod at her to open the door.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M64_F2.jpg"}},{"insert":"\n\n"},{"insert":"You are introduced to 35-year-old Claire Morris, a teacher at the nearby high school.\n\n\u0022I\u0027ve got moles all over my body, doctor\u0022, she says, and continues, \u0022my mother wanted me to have them checked out. She\u0027s worried that I might get melanoma, like my grandmother\u0022.\n\nYou ask a few questions, and find out that she is asymptomatic and completely healthy. Aside from her grandmother developing melanoma, her family history is unremarkable.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M64_F3.jpg"}},{"insert":"\n\n"},{"insert":"You proceed with the physical examination.\n\nClaire has blonde hair and pale white skin; her Fitzpatrick skin phototype is 1. She says that she tends to burn easily, and never tans.\n\nCareful inspection reveals four skin lesions that are potentially of concern:\n\n- Left shoulder: 9mm diameter, asymmetric shape, spiculated margins, shades of black and brown. Claire feels the mole is evolving, but isn\u0027t sure. \r\n- Right breast: 7mm diameter, asymmetric, regular borders, shades of black and brown. \r\n- Right forearm: 2mm diameter, symmetric, regular borders, perfectly round shaped, intense black. Claire can\u0027t remember if the mole is new or old. \r\n- Left calf: 6.5mm diameter, irregular and poorly defined borders, variable shades of brown.\n"}]}


{"ops":[{"insert":"In summary, there are three lesions that are ABCDE positive (the left shoulder, left calf and right breast), and one lesion that is ABCDE negative (right forearm).\n\nThe remainder of the examination is unremarkable.\n"}]}