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LEARNING OBJECTIVES

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

  • 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.

PATIENT PRESENTATION

Chief Complaint

“I have ongoing back pain for 8 weeks that has not resolved with over-the-counter treatments.”

HPI

James Conley is a 62-year-old Caucasian man who presents with an 8-week history of mid-back pain. He has no history of recent injury or trauma to the area. He reports that his back pain continues to increase despite rest and applications with cold and heat. He rates his pain at its worst as 5 on 0–10 scale. The pain is present with movement and at rest. The pain does not radiate. He denies associated numbness or tingling. He has tried various medications including ibuprofen, naproxen, and acetaminophen.

PMH

GERD

Type 2 DM

Stage IIIC melanoma of the right scapular area (T4b N1b M0; diagnosed 2 years ago in Australia; Breslow thickness 4.9 mm with ulceration. S/P wide local excision with right axillary lymph node dissection; 1 out of 32 nodes showed evidence of involvement; there was no evidence of distant disease. Patient declined adjuvant treatment at the time because he was about to move to the United States to work for an advertising agency.

FH

Patient has two sisters; one with type 2 DM. Mother is 83 years old with a history of cutaneous basal cell carcinomas and stage IIA melanoma. Father died at age 71 secondary to heart disease.

SH

The patient is an advertising and commercial photographer. He is married with one daughter (age 27) who is healthy. He smoked one-half pack of cigarettes per day for 4 years while in college; has not smoked for the past 40 years. He has one to two alcoholic drinks on the weekends. He denies illicit drug use. As a child, he spent a significant amount of time outdoors in Australia. He was a summer lifeguard for 8 years. He did not routinely use sunscreen and has a history of sunburns, some blistering.

Medications

Omeprazole 20 mg orally once daily

Glipizide 10 mg orally once daily

Metformin 1000 mg orally twice daily

Ibuprofen 400 mg orally every 4–6 hours as needed for back pain

Allergies

NKDA

ROS

Low back pain as ...

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