Primary Diagnosis
Based on the information given as part of the case study, the primary diagnosis for K.B. is melanoma. Melanoma is considered as a type of cancer that affects the pigment-containing cells, melanocytes, as it affects the skin (Hodi et al., 2010). From the information gathered, K.B. may be diagnosed with melanoma taking into account that it shows symptoms that include a mole that constantly changes in size, does not have a regular shape, changes in overall color and appearance, and results in itchiness or scaling. When comparing the symptoms associated with melanoma to the patient data, what is clear is that they show notable similarities that would lead to the ultimate conclusion that K.B. may be suffering from melanoma. On the other hand, melanoma results from exposure to ultraviolet light, which can be seen from the sun or tanning devices (Wolchok et al., 2013). K.B. indicates that, as a teen, he worked on the outside and tanned several times a month; thus, meaning that he may have been exposed to UV light.
Differential Diagnosis
Nevus : Nevus, which refers to a medical term associated with a mole, is a self-diagnosable condition that results from moles that are often found in different parts of the body. The moles, which are found in areas that are exposed to the sun, are categorized as being brown, smooth, and, in some cases, slightly raised.
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Seborrheic keratosis : Seborrheic keratosis is considered as a non-cancerous condition that often appears as a waxy or tan growth. However, it is essential to note that this condition is most common among older persons and appears on the chest, face, shoulders, and back.
Dysplastic nevi : Dysplastic nevi are considered as moles that are often larger when compared to the average moles that can be found on one's skin surface. These moles are also considered as being irregular and tend to have an uneven color from the center, which is darker, to the edges, which are lighter and patchy. The condition is hereditary; thus, meaning that it can be passed on from parents to children.
Role of Patient History and Physical Exam
The purpose of patient history and physical exam cannot be ignored when engaging in diagnosis, as a health officer involved will be in a much better position through which to narrow the diagnosis workup leading to accuracy in the diagnosis (Balch et al., 2009). In the case of K.B., what is clear is that the patient history presented reflects more on the fact that he may be suffering from the four conditions, as have been indicated. That may act as a significant challenge considering that it becomes much harder when seeking to enhance accuracy in the overall diagnosis process. Consequently, this creates the need for a physical exam to help in ruling out some of the possible diagnoses.
The physical exam was able to offer crucial evidence that was important in pruning the evidence list focusing on the health condition that K.B. was suffering from based on the history that he had presented. For example, the physical examination was able to show that the mole was irregular and was about 0.2cm in size. Ultimately, this was important in ensuring that the evidence list would be narrowed down significantly with the focus being towards ensuring that the correct diagnosis would be presented. Using both the patient history and physical exam, it was clear that K.B. suffered from melanoma as an accurate diagnosis focusing on the information gathered.
Potential Treatment Options
Taking into account that K.B. may be diagnosed with melanoma, the treatment options considered will depend on the stage of the condition, as this is the type of cancer; thus, meaning that different stages present different approaches to treatment. However, the first treatment option that may be considered based on the information gathered would be surgery (wide excision) with the aim being towards removing the mole and a small margin of healthy skin that can be found around the mole. Complete removal is considered with the objective is towards preventing further spread of the condition to other parts of the skin, which would have severe implications for the patient (Buttaro, Trybulski, Polgar-Bailey, & Sandberg-Cook, 2017). The skin will then be taken for further sampling to determine whether the melanoma cells can be seen on the edge of the healthy skin to determine the extent of spread for the condition.
Another treatment option that would be considered when dealing with K.B. would be targeted therapy, which would involve intake of a wide array of medication with the aim being towards reducing the spread of melanoma. K.B. may be expected to take antiviral drugs, which will be of great value towards reducing the ability for the melanoma cells to replicate. Additionally, K.B. will also be expected to go through immunotherapy, which is an approach through which to help boost his immune response when seeking to deal with a disease. In this case, immunotherapy will be focused more on dealing with the underlying effects associated with melanoma as the primary condition that he may have been diagnosed with based on the information given in the case study.
References
Balch, C. M., Gershenwald, J. E., Soong, S. J., Thompson, J. F., Atkins, M. B., Byrd, D. R., ... & Eggermont, A. M. (2009). The final version of 2009 AJCC melanoma staging and classification. Journal of clinical oncology , 27 (36), 6199.
Buttaro, T. M., Trybulski, J., Polgar-Bailey, P., & Sandberg-Cook, J. (2017). Primary care: A collaboration practice , 5 th edition. Elsevier Health Sciences, pp.237-325.
Hodi, F. S., O'Day, S. J., McDermott, D. F., Weber, R. W., Sosman, J. A., Haanen, J. B., ... & Akerley, W. (2010). Improved survival with ipilimumab in patients with metastatic melanoma. New England Journal of Medicine , 363 (8), 711-723.
Wolchok, J. D., Kluger, H., Callahan, M. K., Postow, M. A., Rizvi, N. A., Lesokhin, A. M., ... & Burke, M. M. (2013). Nivolumab plus ipilimumab in advanced melanoma. New England Journal of Medicine , 369 (2), 122-133.
