| Course | NUR-7070 Primary Care Diagnosis, Management and Health Promotion |
|---|---|
| Module | Module 6 |
| Paper type | Advanced assessment and procedure case |
| Length | About 1,100 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | M.S. in Nursing, Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NUR 7070 Module 6
His Wife Saw It Change: ABCDE, Dermoscopy and an Excisional Biopsy With Narrow Margins for a Pigmented Lesion on a 47-Year-Old Landscaper's Back
Student Name
M.S. in Nursing, Family Nurse Practitioner, Thomas Edison State University
NUR-7070: Primary Care Diagnosis, Management and Health Promotion
Mentor Name
Month Day, Year
His Wife Saw It Change: ABCDE, Dermoscopy and an Excisional Biopsy With Narrow Margins for a Pigmented Lesion on a 47-Year-Old Landscaper's Back
Introduction
Mr. P. is an invented patient, a 47-year-old who has run a landscaping business in Morris County for 25 years. His wife made the appointment after noticing that a mole between his shoulder blades looked larger and darker than it had in the spring. He cannot see it himself and has no symptoms from it. He has light skin that burns easily, had several blistering sunburns as a teenager and rarely wears a shirt in summer. Years ago his father had a skin cancer cut from the side of his nose. He is on no daily medication and reports no drug allergy. On examination he has many freckles and about 40 moles. The lesion of concern is 8 millimeters across, asymmetric, with an irregular, notched border and shades of brown, black and a small gray area. It looks different from his other moles.
Assessing the Lesion
The original four letters (uneven shape, ragged edge, mixed color, width over 6 millimeters) date from 1985 and were meant to help both clinicians and the public spot melanoma early. Abbasi et al. (2004) argued for adding a fifth letter, E for evolving, since a mole that changes in size, outline, color or feel is among the strongest alarms and can flag a melanoma while it is still under 6 millimeters. Mr. P.'s mole meets every letter: lopsided, with a notched rim, three shades from brown through black to gray, 8 millimeters across and visibly changed since spring. Among his 40 or so moles it stands out as the odd one, the ugly duckling sign that helps most in people with many moles.
His risk factors add weight: fair skin, blistering sunburns in youth, decades of outdoor work, many moles and a family history of skin cancer.
What Dermoscopy Adds
Dermoscopy uses a handheld magnifier with polarized light or immersion fluid to show pigment patterns and structures beneath the skin surface. Vestergaard et al. (2008) pooled studies performed in clinical settings and found that dermoscopy significantly improved the accuracy of melanoma diagnosis compared with examination by the naked eye, mainly by increasing sensitivity, so fewer melanomas were missed. Under dermoscopy, Mr. P.'s lesion shows an atypical pigment network, irregular dots and globules and an area of blue-white veil, features associated with melanoma. These findings confirm the need for biopsy. Dermoscopy does not replace histology, and a primary care clinician with limited training should biopsy a lesion that is suspicious on clinical grounds even if dermoscopy is reassuring.
Photographs taken with and without the dermatoscope are saved to his record. If the pathology is benign, the images give a baseline for his other atypical moles, and if it is not, they help the specialist see what the lesion looked like before it was removed.
Choosing the Biopsy Technique
How a suspicious lesion is sampled matters, because the pathologist must measure its depth, the Breslow thickness, which drives staging and treatment. The 2019 American Academy of Dermatology guideline (Swetter et al., 2019) recommends a narrow excisional biopsy that removes the entire lesion with 1 to 3 millimeter margins of normal-looking skin, extending into the subcutaneous fat, as the preferred approach. Partial biopsies, such as a superficial shave or a punch through part of the lesion, risk missing the deepest part and underestimating thickness. A wide excision is not done at this stage, because if the lesion is melanoma the definitive margins depend on its thickness, and early wide excision can interfere with later lymph node mapping.
An 8-millimeter lesion on the back can be removed by elliptical excision in the office. The ellipse is oriented along the skin's tension lines, about three times as long as it is wide, so it closes without puckering.
Sending him to dermatology is the other path, and the better one for a spot on the face, ear, hand or genitals, where there is little spare skin and the scar shows, or for a clinician without excision training. On the back, with ample skin and a trained clinician, an office excision avoids a wait of several weeks for a lesion that has already changed.
Consent and Preparation
Informed consent covers the purpose, to remove the lesion and send it for diagnosis, the procedure, the risks, including bleeding, infection, a scar and rarely nerve injury, and the alternative of referral to a dermatologist. Mr. P. is told the results take about a week and that the diagnosis may need further surgery. His consent is documented. The area is cleaned with chlorhexidine, the margins are marked 2 millimeters from the visible edge, and lidocaine 1 percent with epinephrine is injected around the lesion; epinephrine reduces bleeding and is safe on the back.
| Step | Detail for Mr. P. |
|---|---|
| Margins | 2 mm around the visible lesion |
| Depth | Into subcutaneous fat |
| Shape | Ellipse about 3:1, along tension lines |
| Anesthesia | Lidocaine 1 percent with epinephrine |
| Closure | Layered sutures; skin sutures out in 10 to 14 days |
| Specimen | Labeled with site and orientation; sent for histology |
The Procedure and Specimen
The ellipse is cut through the dermis to fat, the specimen is lifted with care to avoid crushing it, and bleeding is controlled. Because the back is under tension, deep absorbable sutures reduce strain before the skin is closed. The specimen is placed in formalin and labeled with the exact site and an orientation suture, and the request form includes his history and the clinical concern for melanoma, which helps the pathologist.
Aftercare and Follow-Up
Mr. P. is taught to keep the dressing dry for 24 hours, then wash gently, watch for redness, warmth or drainage and avoid heavy lifting at work for two weeks, since tension on the back can open the wound. Sutures are removed in 10 to 14 days. The pathology result is reviewed with him in person. If it shows melanoma, he is referred to a dermatologist or surgical oncologist for wide excision based on its thickness. Whatever the result, his risk factors call for a full skin examination by a dermatologist, sun protection at work and teaching his wife how to check his back monthly.
Conclusion
Mr. P.'s lesion met all five ABCDE criteria, stood out from his other moles and showed melanoma features on dermoscopy. Following the 2019 AAD guideline, it was removed whole with narrow margins so that its depth can be measured, with consent, careful technique and specimen handling. His follow-up plan addresses both the result and the risks that will continue throughout his working life.
References
Abbasi, N. R., Shaw, H. M., Rigel, D. S., Friedman, R. J., McCarthy, W. H., Osman, I., Kopf, A. W., & Polsky, D. (2004). Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. JAMA, 292(22), 2771-2776. https://doi.org/10.1001/jama.292.22.2771
Swetter, S. M., Tsao, H., Bichakjian, C. K., Curiel-Lewandrowski, C., Elder, D. E., Gershenwald, J. E., Guild, V., Grant-Kels, J. M., Halpern, A. C., Johnson, T. M., Sober, A. J., Thompson, J. A., Wisco, O. J., Wyatt, S., Hu, S., & Lamina, T. (2019). Guidelines of care for the management of primary cutaneous melanoma. Journal of the American Academy of Dermatology, 80(1), 208-250. https://doi.org/10.1016/j.jaad.2018.08.055
Vestergaard, M. E., Macaskill, P., Holt, P. E., & Menzies, S. W. (2008). Dermoscopy compared with naked eye examination for the diagnosis of primary melanoma: A meta-analysis of studies performed in a clinical setting. British Journal of Dermatology, 159(3), 669-676. https://doi.org/10.1111/j.1365-2133.2008.08713.x
Reading the NUR 7070 Module 6 assignment instructions
The NUR-7070 catalog entry closes on hands-on skills, safe examination and office procedures, and since TESU offers no syllabus for the course, this sixth module takes one procedure from start to finish. Expect a paper that justifies a procedure from the assessment, describes indications, consent, technique, specimen handling and aftercare, and cites the guideline that governs the choice of technique. Some classrooms ask for a different procedure, such as a joint injection, wound closure or incision and drainage, or for a skills reflection. Check the directions. Procedures done in your clinical hours are logged separately; this paper is the written analysis your course asks for.
Inside the NUR 7070 Module 6 example
A 47-year-old landscaper whose wife noticed a changing mole on his back is described with his sun history and a detailed lesion examination. The assessment applies all five ABCDE criteria and the ugly duckling sign. A dermoscopy section uses a meta-analysis to explain what the tool adds and its limits. The technique section follows the 2019 AAD guideline to choose a narrow excisional biopsy and explains why shave and wide excision are not used. Consent, anesthesia and a six-row procedure table follow, then the excision, closure and specimen labeling. Aftercare, pathology follow-up and lifelong skin checks close the paper. A margin note explains why the request form to the pathologist matters as much as the incision.
Where the marks sit in the NUR 7070 Module 6 rubric
Procedure papers are graded on whether the indication is clear, the technique matches current guidance, consent is complete and the steps are described accurately and safely. Mentors look for the reason a particular technique was chosen over alternatives, especially when the choice affects diagnosis, as biopsy depth does for melanoma. Specimen handling, aftercare and follow-up of results are often part of the rubric. Assessment findings should be described precisely, using a recognized framework. The AAD guidance and other current sources, cited in APA, close out the grade. A table of procedural details helps if it adds specifics rather than repeating the text, such as margins, anesthesia and suture timing. Saying when you would refer instead of performing the procedure yourself shows judgment about scope.
NUR 7070 Module 6 help from the desk
Students often describe the steps of a procedure without explaining why it was chosen or why alternatives were rejected. Lead with the indication and the guideline. Another weakness is incomplete consent, missing risks or alternatives. Do not forget specimen handling and how results will be communicated, since a lost or unlabeled specimen undoes the procedure. Describe the lesion with measurements and a recognized framework. Make aftercare specific to the patient's work. Never present a procedure as done on a real patient in a classroom paper unless your directions ask for a de-identified clinical case. Tell the desk which procedure your NUR-7070 prompt names and it will draft the paper to that prompt, the first one at no cost.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 7070 Module 6 questions, answered
Where can I find a free NUR 7070 Module 6 sample paper?
This page shows the whole paper. It assesses a changing mole with ABCDE and dermoscopy and removes it by excisional biopsy with narrow margins.
What does ABCDE stand for in melanoma screening?
Asymmetry, border irregularity, color variegation, diameter over 6 millimeters and evolving, meaning change in size, shape, color or symptoms.
Which biopsy is recommended for a suspected melanoma?
The dermatology academy's 2019 guidance favors taking the whole lesion out with a thin rim of normal skin, one to three millimeters, cut down to fat so its thickness can be measured.
Why not do a shave biopsy of a suspicious mole?
A superficial shave may miss the deepest part of the lesion and underestimate its thickness, which is needed for staging and treatment.
Does dermoscopy improve melanoma diagnosis?
A meta-analysis of clinical studies found that dermoscopy improved diagnostic accuracy over naked eye examination, mainly by catching more melanomas.