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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify risk factors for developing melanoma.

  • Determine treatment options for metastatic melanoma.

  • Prepare educational information to provide to a patient receiving treatment for metastatic melanoma.

  • Discuss ways to prevent melanoma.

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PATIENT PRESENTATION

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Chief Complaint

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“I have been getting short of breath walking to work lately.”

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HPI

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Douglas Kenney is a 52-year-old Caucasian man who presents with increasing shortness of breath and dyspnea on exertion. He denies chest pain and hemoptysis. He reports that he could not walk more than one block without having to stop to catch his breath today. He normally walks 10 blocks to and from work each day and has noted progressive shortness of breath each week for the past 2–4 weeks. He has a history of a left lower leg thrombosis diagnosed 2 months ago after returning home from a trip to Australia. He also has a history of Stage IIA melanoma (T3a, N0, M0) diagnosed 4 years ago.

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PMH

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  • GERD

  • Type 2 DM

  • DVT of the LLE, diagnosed 2 months ago

  • Melanoma (Stage IIA, superficial spreading, Breslow’s thickness of 1.2 mm); diagnosed 4 years ago; left lower back—s/p wide surgical excision—sentinel lymph node biopsy was negative for melanoma

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FH

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Patient is oldest of three children; he has two sisters, both alive; one with type 2 diabetes mellitus. Mother is age 74 with a history of basal cell carcinoma and melanoma skin cancers and heart disease. Father deceased at age 71 secondary to pneumonia.

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SH

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The patient is employed as an architect and is married with one daughter (age 17). He has a history of smoking cigarettes, 0.5 pack per day for 4 years in college. He is a social drinker and reports no illicit drug use.

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Meds

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  • Lansoprazole 30 mg PO once daily

  • Glipizide 10 mg PO once daily

  • Metformin 1,000 mg PO twice daily

  • Enoxaparin 100 mg SC twice daily

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All

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NKDA

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ROS

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Denies fever, chills, rigors, and chest pain; (+) shortness of breath and DOE

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Physical Examination

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Gen
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Slightly overweight Caucasian man in mild respiratory distress

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VS
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BP 129/72 mm Hg, P 92 bpm, RR 22, T 37.8°C; Wt 102.2 kg, Ht 5′10″

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Skin
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Fair skin, multiple scattered dysplastic nevi covering trunk and torso; left lower back melanoma excision site noted, which is well healed. Small bruises on abdomen and upper thighs related to enoxaparin injection sites.

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HEENT
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PERRLA, ...

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