Reference no: EM133707693

Introduction Recap:

The integumentary system, encompassing the skin and its appendages, is organized into three primary layers: the epidermis, dermis, and hypodermis.

Epidermis:
· The outermost layer, the epidermis, is a stratified epithelium primarily composed of keratinocytes. These cells undergo constant renewal, with new cells generated at the basal layer and migrating towards the surface.
· Melanocytes, located in the basal layer, produce melanin-a pigment responsible for skin color and protection against ultraviolet (UV) radiation.
· Specialized cells like Merkel cells contribute to sensory reception, forming connections with nerve endings.

Dermis:
· Beneath the epidermis lies the dermis, a connective tissue layer rich in blood vessels, nerves, and accessory structures.
· Fibroblasts, collagen, and elastin fibers provide structural support and elasticity.
· Blood vessels regulate temperature by constricting or dilating to control heat exchange.
· Nerve endings in the dermis allow for the perception of touch, temperature, and pain.
· Appendages such as hair follicles, sweat glands, and sebaceous glands are embedded in the dermal layer.

Hypodermis:
· The hypodermis is a subcutaneous layer consisting of adipose tissue and loose connective tissue.
· It serves as insulation, regulating body temperature and providing a cushioning effect.
· Blood vessels within the hypodermis supply the skin with nutrients and play a role in thermoregulation.

Scenario/Summary

The skin's tenacious barrier protects the integumentary system, which serves as the body's first line of defense. This dynamic system, comprising the skin, hair, nails, and associated glands, serves as both a protective shield and a sensory interface with the external environment. Understanding the nuances of the integumentary system becomes pivotal when confronted with clinical scenarios, such as the case of Ms. Rodriguez, which unravels the intricate relationship between the skin's structure and the devastating progression of malignant melanoma.

Ms. Rodriguez, a 42-year-old woman with fair skin and a history of intermittent sun exposure, presents to her dermatologist with a concern about a changing mole on her back. She reports that the mole, which she has had for several years, has recently become darker, larger, and irregular in shape. Ms. Rodriguez also notes occasional itching and tenderness around the mole.
During the dermatological examination, the healthcare provider observes a pigmented lesion with uneven borders and multiple colors. A detailed skin examination reveals several other moles, but one mole, in particular, stands out as irregular. The dermatologist decides to perform a skin biopsy of the suspicious mole.

The histopathological examination of the biopsy specimen confirms the diagnosis of melanoma.

Malignant
melanoma
General overview of melanoma
- Malignant melanoma is the least common type of skin cancer, but the most dangerous due to the risk of spread.
- This is a rarer but more serious form of skin cancer arising from the melanocytes of the skin.
- It grows quickly & and metastasizes to other parts of the body.
- Malignant melanomas have these four characteristics:

- A melanoma is typically brown/black which represents color changes in a preceding naevus or the appearance of a new pigmented lesion frequently goes unnoticed, particularly if on the back.
- Itchiness or bleeding are sinister symptoms.
- It is highly metastatic & and resistant to treatment.
- It can spread even at a small size into internal organs & the brain or spinal cord, & and the lungs.
- This tumor develops from the melanocytes of the epidermis (black skin cancer).
- Melanomas are treated with a wide, deep surgical excision along with immunotherapy.

Squamous cell carcinoma
- SCCs are usually well circumscribed, appearing as nodules, nodules with some central ulceration or ulcers with raised, everted, nodular edges.
- Squamous cell carcinoma, the second most common skin cancer, tends to grow rapidly & can potentially spread if not removed.
- This tumor develops from the flat, squamous cells of the epidermis.
- Squamous cell carcinoma lesions tend to look like crusty sores that won't heal.
- This cancer is most commonly found on the scalp, scalp, ears, lower lip, & hands.
- It has a good prognosis if treated early by radiation therapy & surgical excision.

Basal cell carcinoma
- Basal cell carcinoma is the least malignant of the skin cancers & also the most common type of skin cancer.
- Bcc is very rare in non-hair-bearing skin such as the palms & soles.
- A bcc can also appear predominantly nodular, ulcerating or mixed, & often have characteristic surface telangiectasia & a ‘pearly' appearance.
- Bcc begins in the basal cell layer of the epidermis, usually develops on chronically sun - exposed areas of the skin, rarely metastasizes, & is usually slow growing.

Deliverables

Please address the following questions in complete sentences.

1. Which epidermal layer do melanocytes arise from?

2. Which skin cancer is the MOST AGGRESSIVE & MOST LIKELY to metastasize?

3. Which skin cancer is the Second most aggressive skin cancer?

4. Which skin cancer is the LEAST aggressive and LEAST likely to metastasize?

5. Using the clinical vignette only, list the risk factors found in this client that contributed to the development of malignant melanoma.