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NR 283 Pathophysiology Paper

Introduction of Disease

Melanoma is a type of skin cancer characterized by its malignant nature. Although it is not the most prevalent form of skin cancer, it is the most dangerous. Melanocytes located at the boundary between the epidermis and dermis are responsible for producing melanin when exposed to UV rays. This melanin gives the skin its darker pigmentation. According to Harting (2014), the incidence of malignant melanoma has steadily increased over the past three decades, now ranking as the fifth most common tumor.

While the number of diagnosed cases continues to rise, numerous preventive measures are available to reduce the risk of skin cancer.

Etiology

Excessive exposure to UV radiation is the primary cause of skin cancer. While two genes are suspected to play a role in skin cancer susceptibility, no conclusive evidence has been found to support this claim (Porth & Gaspard, 2014). The presence of melanin in the skin provides a certain degree of protection against the harmful effects of UV radiation. UV exposure mainly occurs from the sun’s rays and tanning bed lights. It is essential to take precautions, even when using tanning beds like those taken outside.

NR 283 Pathophysiology Paper

During winter, UV rays can be intensified by reflecting off the snow. Long car drives also pose a risk as the windows amplify UV rays. Individuals who drive for extended periods, particularly on the left side of their bodies facing the window, have an increased risk. This risk is particularly significant for those with fair skin, such as Caucasians, with a substantially higher susceptibility to skin cancer.

Individuals with blonde or red hair and blue or green eyes are also at a higher risk. The presence of numerous freckles and moles indicates an increased risk as well since UV radiation can lead to mutations in these cells. Men have a higher incidence of skin cancer compared to women. Other risk factors include a family history of malignant melanoma, severe sunburns during childhood, and previous occurrences of malignant melanoma (Harting, 2014).

Pathophysiology Processes

Malignant melanoma, a type of skin cancer, develops due to the mutation of melanocytes, the cells responsible for producing melanin and giving color to the skin, including freckles and moles. When exposed to UV radiation, the genetic material within skin cells can be damaged, leading to mutations. Over time, these mutations can result in uncontrolled cell growth and the formation of cancerous tumors. This progression typically starts with dysplasia, where abnormal changes occur in the cells, and may advance to anaplasia, characterized by further loss of cellular differentiation (VanMeter & Hubert, 2014).

NR 283 Pathophysiology Paper

Although genetic factors have been observed in some individuals with melanoma, there is currently no conclusive evidence linking these factors directly to melanoma development (Harting, 2014). While the body has mechanisms to repair damaged DNA, there can come a point where the cells proliferate too rapidly for the repair processes to keep up. It is important to continue researching and understanding the complex factors involved in melanoma development to advance prevention and treatment strategies further.

Clinical Manifestations and Complications

The ABCDE method is commonly used as a self-diagnostic tool for identifying potential signs of malignant melanoma. Each letter represents a different characteristic when examining moles or skin lesions. This stands for asymmetry, where one half of the mole does not mirror the other. B represents the border, which may appear irregular, jagged, or notched. C denotes coloring, explicitly looking for variations in shades of brown or black within the mole. D indicates the diameter, with moles more significant than the size of a pencil eraser, warranting closer attention. Finally, E signifies any evolution or changes in the mole’s size, shape, or color over time.

In addition to the ABCDE criteria, other signs may indicate a potential melanoma. These include non-healing sores, bleeding, raised or elevated areas, crusting, tenderness, or itching (Schub & Holle, 2017). Be vigilant and seek medical attention if these signs are present, as early detection is crucial for effective treatment.

If left untreated, melanoma has the potential to metastasize and spread to other parts of the body through the lymphatic system, leading to life-threatening complications (Porth & Gaspard, 2014). Therefore, it is essential to promptly address any suspicious skin changes and consult with a healthcare professional for proper evaluation and management.

NR 283 Pathophysiology Paper

Diagnostics

A biopsy of the suspicious lesion is performed to confirm a diagnosis of malignant melanoma. The biopsy involves removing a tumor sample, which a pathologist then examines. The cancer is assessed and staged during the pathological examination using the Clark level. The Clark level provides information about the depth of invasion of the tumor, ranging from the epidermis (top layer of the skin) to the subcutaneous tissue (deeper layers beneath the skin).

In addition to staging, the spread of the cancer is determined using the tumor, nodes, and metastasis (TNM) system. This system evaluates whether the cancer has spread to nearby lymph nodes or other body parts. If nodal involvement is suspected, further diagnostic tests such as X-rays, positron emission tomography (PET) scans, and magnetic resonance imaging (MRI) may be performed to assess the extent of the spread (Harting, 2014).

Specific blood tests can also provide valuable information during the diagnostic and treatment process. Elevations in serum lactate dehydrogenase, liver function test results, and S-100 protein levels may indicate abnormal activity associated with melanoma (Harting, 2014). Additionally, during treatment, changes in blood parameters may occur, such as a decrease in hemoglobin levels (anemia) and an increase in white blood cell counts (indicative of infection) (Schub & Holle, 2017).

NR 283 Pathophysiology Paper

These diagnostic evaluations and blood tests play a crucial role in determining the stage of melanoma, guiding treatment decisions, and monitoring the patient’s response to therapy.

References

Harting, D. (2014). Malignant Melanoma. Radiation Therapist, 23(1), 51-76. Porth, C, M. & Gaspard, K. J. (2014). Essentials of pathophysiology: Concepts of altered states (4th ed.). Philadelphia, PA, United States: Lippincott Williams and Wilkins. Schub, T., & Holle, M. N. (2017). Melanoma. CINAHL Nursing Guide VanMeter, K. C. & Hubert, R. J. (2014). Gould’s pathophysiology for the health professions (5thed.). St. Louis, MO: Elsevier Saunders.

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