Develop a 1- to 2-page case study analysis by answering the questions provided following the case scenario.
Case Study Analysis of a 57-Year-Old Male with Melanoma
A 57-year-old man presented with a dark lesion on his upper right arm that appeared to have changed in size. Biopsy confirmed the presence of atypical melanocytes consistent with melanoma. The purpose of this study is to analyze the pathophysiology, genetic basis, and immune impact of melanoma while considering treatment strategies.
Patient Signs and Symptoms
The patient reported a dark lesion on his upper right arm that appeared different from his usual freckles. He denied pain, rash, fever, or breathing problems. The clinical concern was the change in the lesion size, which often signals malignancy. Biopsy revealed atypical melanocytes with irregular nuclei and prominent nucleoli, confirming the malignant transformation.
The presence of cells invading the dermis in nests and sheets supported the diagnosis of melanoma. Mart-1 positivity confirmed melanocytic origin. The main symptom in this case was a visible skin lesion with progressive change, which is a classic warning sign of skin cancer.
Primary Pathophysiological Processes
Melanoma develops when melanocytes, the pigment-producing cells in the skin, undergo abnormal growth and division (Scheau et al., 2021). In this case, atypical melanocytes were located in the basal epidermis and had invaded the dermis. These cells lost normal growth control and formed irregular clusters. The abnormal nuclei and nucleoli indicated uncontrolled proliferation.
The invasion into the dermis is significant because it allows malignant cells to access blood vessels and lymphatics, increasing the risk of metastasis (Scheau et al., 2021). This explains why visible changes on the skin, such as size and shape alteration, reflect deeper cellular damage.
Role of Genetic Mutations
Genetic mutations are central to melanoma development. Mutations in genes such as BRAF, NRAS, and c-KIT disrupt pathways that regulate cell growth and survival (Mahumud & Shahjalal, 2022). BRAF mutations, for example, activate the MAPK pathway, leading to continuous cell division. These mutations result from DNA damage, often caused by ultraviolet radiation exposure.
When DNA repair mechanisms fail, melanocytes accumulate errors and progress toward malignancy (Mahumud & Shahjalal, 2022). In this patient, the histological changes reflect underlying genetic alterations that allow cells to bypass normal checkpoints and continue dividing without control.
Impact on the Immune System
Melanoma affects the immune system by evading immune surveillance. Malignant melanocytes can produce signals that suppress immune activity (Indini et al., 2021). They may downregulate antigen presentation or express proteins such as PD-L1 that inhibit T cell function. This allows the tumor to grow unchecked despite immune defenses. Over time, the immune system becomes less effective at recognizing and destroying melanoma cells (Indini et al., 2021). This immune evasion explains why melanoma can progress even in otherwise healthy individuals.
Treatment Strategies Targeting Pathophysiology
Treatment approaches for melanoma are designed to address the abnormal growth and immune evasion. Surgical excision remains the primary strategy for localized disease. For advanced cases, targeted therapies such as BRAF and MEK inhibitors directly block abnormal signaling caused by genetic mutations (Lopes et al., 2022). Immunotherapy, including checkpoint inhibitors like anti-PD-1 antibodies, restores T cell activity and enhances the immune response against melanoma (Lopes et al., 2022).
These treatments are successful because they act on the same pathways and mechanisms that drive disease development. The combined use of surgery, targeted therapy, and immunotherapy addresses both the cellular and immune processes central to melanoma progression.
Conclusion
The patient presented with a suspicious skin lesion that was confirmed as melanoma through biopsy. The disease arises from genetic mutations in melanocytes, leading to uncontrolled proliferation and invasion. Melanoma evades the immune system, but treatments such as targeted therapy and immunotherapy improve patient outcomes. The purpose of the study has been fulfilled by examining the signs, pathophysiology, genetic factors, and treatment approaches.
References
Indini, A., Grossi, F., Mandalà, M., Taverna, D., & Audrito, V. (2021). Metabolic interplay between the immune system and melanoma cells: Therapeutic implications. Biomedicines, 9(6), 607. https://doi.org/10.3390/biomedicines9060607
Lopes, J., Rodrigues, C. M., Gaspar, M. M., & Reis, C. P. (2022). Melanoma management: From epidemiology to treatment and latest advances. Cancers, 14(19), 4652. https://doi.org/10.3390/cancers14194652
Mahumud, R. A., & Shahjalal, M. (2022). The emerging burden of genetic instability and mutation in Melanoma: Role of Molecular mechanisms. Cancers, 14(24), 6202. https://doi.org/10.3390/cancers14246202
Scheau, C., Draghici, C., Ilie, M. A., Lupu, M., Solomon, I., Tampa, M., … & Caruntu, C. (2021). Neuroendocrine factors in melanoma pathogenesis. Cancers, 13(9), 2277. https://doi.org/10.3390/cancers13092277
NURS_6501_Week 2_Case Study_Assignment_Rubric
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Develop a 1- to 2-page case study analysis, examining the patient signs and symptoms presented in the case study; discussing the primary cellular pathophysiological processes, and the significance for symptom development and diagnosis.
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What role do genetic mutations play in the development of the disease?
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What is the impact of the disease on the immune system? …… How do treatment strategies target the pathophysiological mechanisms of the disease?
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Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. Content is supported by current evidence-based sources.
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Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation
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Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. |
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