NEWEST I-HUMAN CASE STUDY: THOMAS WARREN, A 72-YEAR-OLD MALE, PRESENTS WITH A COMPLAINT OF AN UNUSUAL MOLE. (RESOURCEFUL CONTENT)

Introduction

The ever-evolving landscape of healthcare has been markedly enhanced by the incorporation of virtual simulation platforms. Among these, the I-Human case studies stand as a paramount tool in medical education, providing professionals and students alike with invaluable experiential learning opportunities. This paper delves into the latest I-Human case study, featuring Thomas Warren, a 72-year-old male who presents with a complaint of an unusual mole. This case not only serves as a learning module but also underscores the critical importance of vigilant dermatological assessment in geriatric patients.

Case Presentation

Thomas Warren, a 72-year-old Caucasian male, approached his primary care physician with concerns about a recently altered mole on his left upper back. The patient's medical history was significant for basal cell carcinoma approximately five years prior, successfully excised without recurrence. His family history was notable for melanoma, with his late brother diagnosed at the age of 78. Given this background, the pertinence of a thorough dermatological examination cannot be overstated.

Clinical Examination and Initial Findings

Upon examination, the mole in question measured approximately 6 mm in diameter, exhibiting an asymmetrical shape and heterogeneous coloration, ranging from dark brown to a lighter, almost translucent hue at the periphery. The edges of the mole were poorly defined, contributing to an overall irregular appearance. A palpation did not reveal any tenderness or induration. The initial differential diagnosis considered included melanoma, dysplastic nevus, and a benign seborrheic keratosis.

Diagnostic Approach

Adhering to the protocols of early detection and management of skin malignancies, a biopsy was deemed imperative. An excisional biopsy of the lesion was performed under local anesthesia, ensuring complete removal for pathological examination. The specimen was then sent to histology where it underwent a series of tests including H&E staining, immunohistochemistry for S-100 protein and HMB-45, and a comparative genomic hybridization to assess for chromosomal aberrations.

Pathological Findings

The histopathological examination revealed an atypical melanocytic proliferation with evidence of mitotic activity and architectural disorder. These findings were suggestive of a malignant melanoma. The immunohistochemical markers confirmed the presence of melanocytic cells, and the genomic profiling indicated multiple genetic alterations common in melanoma cases, thus supporting the diagnosis.

Management and Follow-Up

Given the diagnosis of malignant melanoma, an interdisciplinary team was consulted to formulate a management plan. The consensus was to proceed with a sentinel lymph node biopsy to assess for metastatic spread. Fortunately, the sentinel lymph nodes were found to be free of metastasis. The patient was enrolled in a rigorous follow-up schedule, which included regular dermatological assessments and whole-body imaging, to monitor for any signs of recurrence or new lesions.

Discussion

This case study of Thomas Warren highlights several critical elements in the management of skin lesions in the elderly. The evolution of the mole, from a seemingly innocuous lesion to a confirmed melanoma, accentuates the need for meticulous and ongoing skin evaluations, especially in patients with a personal or familial history of skin cancer. Additionally, it underscores the utility of advanced diagnostic tools and the multidisciplinary approach in managing complex cases.

Conclusion

Thomas Warren's case is a quintessential example of the complexities involved in dermatological oncology, particularly within the geriatric population. It demonstrates the vital role of I-Human case studies in simulating real-world scenarios that health professionals may encounter, providing them with a robust platform to hone their diagnostic and clinical decision-making skills. Through such resourceful content, practitioners gain the acumen necessary to navigate the nuances of patient care, ensuring a higher standard of treatment and better patient outcomes.

Reflections on the Case Study

This I-Human case study not only serves as an educational tool but also as a reminder of the relentless progression of medical technology and its profound impact on healthcare delivery. It encourages continuous learning and adaptation in medical practice, hallmarks of an effective healthcare system capable of addressing the myriad challenges posed by complex clinical cases.

Below are sample Questions and Answers:

I-Human Case Study: Thomas Warren, 72 Years Old
Chief Complaint:
Thomas Warren, a 72-year-old male, presents with a complaint of an unusual mole
on his back that he noticed about 3 months ago. He reports that the mole has
changed in size, color, and shape.
Subjective:
History of Present Illness (HPI):
Onset: Noticed the mole 3 months ago.
Location: Middle of the back.
Duration: Persistent since first noticed.
Characteristics: The mole has become larger, darker, and has irregular borders. It
has also become itchy occasionally.
Associated Symptoms: No bleeding, oozing, or pain.
Aggravating Factors: None reported.
Relieving Factors: None reported.
Previous Interventions: No previous treatments or evaluations.
Past Medical History (PMH):
Hypertension (well-controlled with
medication). Hyperlipidemia.
Type 2 Diabetes Mellitus.
Osteoarthritis.
No history of skin cancer or previous skin lesions of concern.
Medications:
Lisinopril 20 mg daily.
Atorvastatin 40 mg daily.
Metformin 500 mg twice daily.
Ibuprofen 200 mg as needed for arthritis pain.
Allergies:
No known drug allergies.
Family History:
Father: Deceased at 85, history of coronary artery disease.
Mother: Deceased at 78, history of hypertension.
No family history of skin cancer.
Social History:
Retired
accountant. Lives