Question

A 44-year-old Caucasian woman is admitted for local wide excision of a large mole that has been diagnosed as malignant melanoma on her upper thigh. Her past history is negative for serious illness. She was hospitalized for the birth of her three children. She admits to being an avid sun worshipper" and is noted to have very dark brown skin and some premature aging of the facial skin. 1. Considering the possible etiology of melanoma, what effect does the exposure to sunlight have on this form of cancer? 2. During her preoperative instructions, the patient asks why she is going to have a 4-inch circle of skin and tissue removed to get rid of a "mole." What information should the nurse consider before responding to her question? 3. The patient has a wide excision of the melanoma, and the surgical site is closed with a split-thickness skin graft from the opposite thigh. Following surgery, the wound is dressed with a bulky dressing, and the donor site is covered with a pressure dressing. When the nurse is assessing the dressings, the patient asks to "peek” at the surgical site so that she can see where the mole had been. How should the nurse respond? 4. On the following morning, the patient reports that the donor site "hurts worse than the cancer site." What should the nurse say and what interventions are appropriate? 5. On the third day after surgery, the bulky dressing is removed. The wound appears wet with cloudy fluid oozing from it, and the skin graft is unattached to the wound. The surrounding tissues are red and swollen. What is the likely cause of these features in the graft site?

Answer 1

1)Etiology of melonoma consists of risk factors such as genetic and environmental factors.Where as mostly melonoma is mostly caused by the exposure of U.V radiation whether it is from sunlight or tanning beds.

As she explained that she is avid sun worshiper then the cause of the cancer is due to exposure to UV radiation.

2)As cancer is mainly of abnormal cell growth.

As if the mole is of small size there is no need for surgery as it can be cut using a knife.

But here 4 inch circle of skin is seen removing so it may be of large mole which may be deeper so surgery is required to remove the mole .In here healthy skin around the mole is also removed along with mole to completely remove the cancer.

3)The nurse should respond by saying that the patient can see the site after it is completely healed so she can have some relief.And if she sees know she may never forget the sight.

4)The nurse should explain that the pain on the donator site is common and it takes time to heal that the surgery site.

Interventions include morphine for pain and the dressing around the wound should be changed regularly with care.

5)The skin graft is failed in this surgery.The reason for this are several which include hematoma and seroma formation is not occur which result in skin graft failure.

The caused redness swelling and discharge from wound which are the symptoms for failure of skin graft.