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Clinical Competency

Jonah Foutz 536-7-12 Team 1. Clinical Competency. The Patient. 38 year old, white female No medications Current tobacco use No significant hospitalizations No allergies. The Case. Large, multi-lobular, localized, sensitive, inflamed, melanotic growth on the back of the neck.

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Clinical Competency

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  1. Jonah Foutz 536-7-12 Team 1 Clinical Competency

  2. The Patient • 38 year old, white female • No medications • Current tobacco use • No significant hospitalizations • No allergies

  3. The Case • Large, multi-lobular, localized, sensitive, inflamed, melanotic growth on the back of the neck. • Sensitive to touch at the moment. • Usually asymptomatic • Has had since birth • Approximately 4 cm in diameter

  4. The Case

  5. Patient dialogue • How long have you had this? • Since I was born • How long has it been hurting? • About a week • Has it hurt before in the past? • Yes, occasionally it will get inflamed. • Has it changed in size, shape, or color over time? • Yes it has gotten larger, but hasn’t changed shape or color. • Have you ever been to a physician about this? • No, but I do want to get it removed.

  6. Differential Diagnosis • Papilloma • Congenital melanotic nevus with ingrown hair that is causing inflammation and pain. • Melanoma

  7. Congenital melanotic nevus with ingrown hair. Treatment- Refer to dermatologist. Other comments- Not harmful so not necessary to remove unless patient desire. May want to due to the many times it gets inflamed from ingrown hairs. Also told to keep an eye on the size, shape and color because these have been known to develop into melanoma in a small percent of cases. Provisional Diagnosis and Treatment

  8. Congenital Melanotic Nevus • Congenital nevi are present at birth and result from a proliferation of benign melanocytes in the dermis, epidermis, or both. The actual etiology is unclear, but congenital nevi are found on 1-2 % of newborns and range in size from small nevi (<1.5 cm), medium nevi (1.5-19.9 cm), and large nevi (>20 cm). The larger the nevi, the greater the chance of developing into a melanoma.

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