Comprehensive Advanced Health
Assessment
Clinical Case Report
iHuman Patient Simulation
Thomas Wilder
Unusual Mole – Malignant Melanoma
E
US
HO
OL
HO
SC
Prepared By: SchoolHouse
MRN: 7842-DERM-WILDER
Academic Draft - For Educational & Simulation Use Only
Advanced Practice Nursing / Clinical Medical Candidate
©SchoolHouse Academic Publishing
,Executive Case Summary
Case Overview
Patient Name: Thomas Wilder Age / Gender: 72 y/o Male
Height / Weight: 6’ 0" (183 cm) / 179 lb (81.4 kg) BMI: 24.3 kg/m² (Normal)
Mr. Thomas Wilder is a 72-year-old retired civil engineer who presents to the outpa-
tient clinic with a chief complaint of an "unusual mole" located on his left upper back
over the scapular region. The patient states that his wife noticed the lesion approx-
imately 8 months ago, and over the past 3 to 4 months, it has undergone noticeable
evolution, including asymmetric expansion, darkening in color, development of irregular
notched borders, and intermittent mild pruritus. He denies overt spontaneous bleeding,
ulceration, or associated pain, but reports occasional friction irritation from shirt collars.
Given the patient’s age, Fitzpatrick Skin Type II (fair skin, blue eyes, tendency to
sunburn), extensive history of recreational sun exposure, and multiple blistering sunburns
E
US
during adolescence and early adulthood, there is a high index of clinical suspicion for
HO
cutaneous malignant melanoma versus an atypically transformed dysplastic nevus or
OL
pigmented basal cell carcinoma.
HO
SC
Core Learning Objectives
1. Advanced Dermoscopic Assessment: Master the recognition of classic visual
and dermoscopic features of malignant melanoma including atypical pigment net-
works, blue-white veils, and asymmetry across dual axes.
2. ABCDE Criteria & Clinical Decision Making: Systematically evaluate pig-
mented skin lesions utilizing the ABCDE rule to differentiate benign lesions from
high-risk cutaneous malignancies.
3. Pathophysiology & Histopathology: Analyze the molecular mechanisms of
melanomagenesis, including UV radiation driver mutations (BRAF V600E), Bres-
low depth micro-staging, and Clark levels.
4. Evidence-Based Surgical & Medical Management: Formulate NCCN guideline-
adherent surgical excision plans (wide local excision margins), sentinel lymph node
biopsy indications, and long-term surveillance protocols.
1
, Comprehensive Patient History &
Interview
History of Present Illness (HPI) Narrative
Mr. Thomas Wilder, a 72-year-old retired Caucasian male, presents with an evolving
skin lesion on his left upper back (scapular region). The lesion was first noticed by his
wife approximately 8 months prior during a routine haircut. At that time, it appeared
as a small, flat, uniform brown spot roughly 4 mm in diameter. Over the last 4 months,
Mr. Wilder notes that the lesion has noticeably enlarged, broadened, and altered in
appearance.
He describes the current lesion as dark brown to pitch black, with uneven pigment
distribution and jagged, irregular borders. Over the past 6 weeks, he has experienced
intermittent localized pruritus (itching rated 3/10) at the site, particularly when sweat-
E
US
ing or wearing coarse clothing. He denies overt spontaneous bleeding, oozing, crusting,
HO
purulent discharge, or localized pain. He reports no prior history of trauma or thermal
OL
injury to the scapular region.
HO
Regarding constitutional symptoms, Mr. Wilder denies systemic fevers, night sweats,
SC
rigors, unexplained weight loss, generalized fatigue, lymphadenopathy, or new bone pain.
He reports no other rapidly growing or changing moles on the remainder of his body,
though he notes numerous "age spots" (seborrheic keratoses) on his anterior chest and
abdomen.
Structured Clinical Interview Matrix
Interview Ques- Patient Response Score Clinical Rationale
tion
How long has this "My wife noticed it about 8 HIGH Establishes chronological
mole been on your months ago. It was small and (100%) timeline and chronicity.
back, and when light brown then, but over the Rapid evolution over
did you first notice last 3 or 4 months it’s gotten months is a classic
changes? much darker and spread out." hallmark of cutaneous
melanoma versus stable
benign nevi.
2
Assessment
Clinical Case Report
iHuman Patient Simulation
Thomas Wilder
Unusual Mole – Malignant Melanoma
E
US
HO
OL
HO
SC
Prepared By: SchoolHouse
MRN: 7842-DERM-WILDER
Academic Draft - For Educational & Simulation Use Only
Advanced Practice Nursing / Clinical Medical Candidate
©SchoolHouse Academic Publishing
,Executive Case Summary
Case Overview
Patient Name: Thomas Wilder Age / Gender: 72 y/o Male
Height / Weight: 6’ 0" (183 cm) / 179 lb (81.4 kg) BMI: 24.3 kg/m² (Normal)
Mr. Thomas Wilder is a 72-year-old retired civil engineer who presents to the outpa-
tient clinic with a chief complaint of an "unusual mole" located on his left upper back
over the scapular region. The patient states that his wife noticed the lesion approx-
imately 8 months ago, and over the past 3 to 4 months, it has undergone noticeable
evolution, including asymmetric expansion, darkening in color, development of irregular
notched borders, and intermittent mild pruritus. He denies overt spontaneous bleeding,
ulceration, or associated pain, but reports occasional friction irritation from shirt collars.
Given the patient’s age, Fitzpatrick Skin Type II (fair skin, blue eyes, tendency to
sunburn), extensive history of recreational sun exposure, and multiple blistering sunburns
E
US
during adolescence and early adulthood, there is a high index of clinical suspicion for
HO
cutaneous malignant melanoma versus an atypically transformed dysplastic nevus or
OL
pigmented basal cell carcinoma.
HO
SC
Core Learning Objectives
1. Advanced Dermoscopic Assessment: Master the recognition of classic visual
and dermoscopic features of malignant melanoma including atypical pigment net-
works, blue-white veils, and asymmetry across dual axes.
2. ABCDE Criteria & Clinical Decision Making: Systematically evaluate pig-
mented skin lesions utilizing the ABCDE rule to differentiate benign lesions from
high-risk cutaneous malignancies.
3. Pathophysiology & Histopathology: Analyze the molecular mechanisms of
melanomagenesis, including UV radiation driver mutations (BRAF V600E), Bres-
low depth micro-staging, and Clark levels.
4. Evidence-Based Surgical & Medical Management: Formulate NCCN guideline-
adherent surgical excision plans (wide local excision margins), sentinel lymph node
biopsy indications, and long-term surveillance protocols.
1
, Comprehensive Patient History &
Interview
History of Present Illness (HPI) Narrative
Mr. Thomas Wilder, a 72-year-old retired Caucasian male, presents with an evolving
skin lesion on his left upper back (scapular region). The lesion was first noticed by his
wife approximately 8 months prior during a routine haircut. At that time, it appeared
as a small, flat, uniform brown spot roughly 4 mm in diameter. Over the last 4 months,
Mr. Wilder notes that the lesion has noticeably enlarged, broadened, and altered in
appearance.
He describes the current lesion as dark brown to pitch black, with uneven pigment
distribution and jagged, irregular borders. Over the past 6 weeks, he has experienced
intermittent localized pruritus (itching rated 3/10) at the site, particularly when sweat-
E
US
ing or wearing coarse clothing. He denies overt spontaneous bleeding, oozing, crusting,
HO
purulent discharge, or localized pain. He reports no prior history of trauma or thermal
OL
injury to the scapular region.
HO
Regarding constitutional symptoms, Mr. Wilder denies systemic fevers, night sweats,
SC
rigors, unexplained weight loss, generalized fatigue, lymphadenopathy, or new bone pain.
He reports no other rapidly growing or changing moles on the remainder of his body,
though he notes numerous "age spots" (seborrheic keratoses) on his anterior chest and
abdomen.
Structured Clinical Interview Matrix
Interview Ques- Patient Response Score Clinical Rationale
tion
How long has this "My wife noticed it about 8 HIGH Establishes chronological
mole been on your months ago. It was small and (100%) timeline and chronicity.
back, and when light brown then, but over the Rapid evolution over
did you first notice last 3 or 4 months it’s gotten months is a classic
changes? much darker and spread out." hallmark of cutaneous
melanoma versus stable
benign nevi.
2
