Case Study-Skin Disorders 1

Integumentary Disorders - Case Study Presentation

Nick J. Chun

Hume Fogg

Author Note

Step 1: Summary of the Facts

(Background Info)

Step 2: Contributions/Testing
to the Problem
(Symptoms & Diagnostic Tests)

Step 3: Solutions/Diagnoses
(3 Possible Diagnoses &
Brief Descriptions)

Step 4: Statement of the Problem

(Actual Diagnoses &
Full Description)

Step 5: Solution Implementation/Treatment

Case Study-Skin Disorders 2

Step 1:

John Doe is a 65 year old white male who has worked as a farmhand since he was a

teenager. His decades of working outdoors can be seen through his wrinkles and sun-damaged

skin. After noticing multiple sores on his neck and head that weren’t healing, John received a

checkup from his dermatologist. Other than the aforementioned affliction, John was a very

healthy individual who loved the outdoors. The scaly lesions were slightly raised ​with

telangiectasia-dilated small blood vessels on the skin(Mayo Clinic).

Step 2:

The dermatologist first conducted a medical exam in which he asked John questions

about skin cancer problems in family, etc. After doing a basic checkup, the dermatologist noticed

that the majority of the lesions were on areas of the body that experienced heavy sun exposure.

Additionally, the dome-shaped structure of the lesions were prone to flattening in the center, and

would ooze pus. The sores were quick to bleed, and had sunken vessels. After eliciting a border

on the lesion, the dermatologist had a very good idea of what the diagnosis was. In order to be

fully sure of his diagnosis of John, the dermatologist opted for a skin biopsy. He removed a

couple of the growths off of John’s back (Carucci), and sent them to a lab to be tested.

Step 3:

The first possible diagnosis could have been Sebaceous Hyperplasia. It is a very

common condition that causes small bumps on the skin. The bumps are most often skin-colored,

but can also take on a white to slightly yellow tint. They range in size from 1 or 2 millimeters to

several millimeters in size. The second possible diagnosis could have been Squamous Cell

Carcinoma or SCC. SCCs could appear as scaly red patches, open sores, rough, thickened or
Case Study-Skin Disorders 3

wart-like skin, or raised growths with a sunken center. At times, SCCs may crust over, itch or

bleed. The lesions most commonly arise in sun-exposed areas of the body. The third diagnosis

could have been malignant melanoma. Regarded as the most dangerous skin cancer, it is when

pigment producing cells become cancerous. This is an aggressive cancer that quickly overtakes,

and forms malignant tumors.

Step 4.

The correct diagnosis as the dermatologist confirmed was Basal cell carcinoma. It is a

form of cancer that affects the mitotically active stem cells in the stratum basale of the epidermis.

It is the most common of all cancers that occur in the United States and is frequently found on

the head, neck, arms, and back, which are areas that are most susceptible to long-term sun

exposure. Although UV rays are the main culprit, exposure to other agents, such as radiation and

arsenic, can also lead to this type of cancer. Wounds on the skin may be predisposing factors as

well. Basal cell carcinomas start in the stratum basale and usually spread along this boundary. At

some point, they begin to grow toward the surface and become an uneven patch, bump, growth,

or scar on the skin surface (Hanke).

Step: 5

Like most cancers, basal cell carcinomas respond best to treatment when caught early.

Treatment options include surgery, freezing, and topical ointments (Mayo Clinic).​All vulnerable

areas that may have sun damage should be checked to exclude other lesions. Excision of the lesion,

with histology of the tissue to confirm the diagnosis and complete removal is the best treatment.

However, the decision on treatment depends on the site, size and depth of the lesion, as well as the

patient's health and acceptance of this approach.Patient should be advised of the risk of recurrence
Case Study-Skin Disorders 4

and should check his skin regularly. He should avoid exposure to sunlight and protect his skin with

clothing, a broad-brimmed hat, and a topical sunscreen of at least SPF 30

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References

Levy R, Hanke W. The nose: a high-risk area for cancer.

www.skincancer.org/skin-cancer-information/ basal-cell-carcinoma/the-nose.

Carucci JA, Leffell DJ. ”Basal Cell Carcinoma” In: Wolff K ​et al. Fitzpatrick’s

Dermatology in General Medicine, 7th edition.​ USA. McGraw Hill Medical; 2008,

p. 1036-42.

Wong CS, Stragne RC, Lear JT et al. “Clinical review: Basal cell carcinoma.” BMJ 2003

Oct 4;327:794-798.

Mayo Clinic (2012). ​Basal cell carcinoma.​ Retrieved

from:​http://www.mayoclinic.com/health/basal-cell-carcinoma/ds00925/dsection=trea
tments-and-drugs​.