Based on information missing from the patient history, suggest other possible diagnoses and explain why.
Week 2 Discussion Post – Case Study 2
The primary diagnosis I would choose for K.B. is seborrheic keratosis. This diagnosis is supported by the irregular borders, seborrheic keratosis’ tendency to mimic malignant melanoma, and the patient’s history of UV light exposure including both sunlight and indoor tanning beds (Luba, et al., 2003; Balin, 2018; Buttaro, et al, 2017). Habif, et al. (2012) provides supporting evidence pertaining to this diagnosis, noting seborrheic keratosis can grow rapidly; this would likely draw the patient’s attention to the changes and increase his concerns. Balin (2018) notes that 0.66% of biopsies performed on lesions diagnosed as seborrheic keratosis did come back positive for malignant melanoma; this would warrant further investigation and confirmation with either a punch biopsy or an excisional biopsy (Luba, et al, 2003; Habif, et al, 2012).
The three differential diagnoses I selected for this patient are malignant melanoma, basal cell carcinoma, and squamous cell carcinoma. Malignant melanoma would be the differential to rule out. Seborrheic keratosis can mimic malignant melanoma in appearance (Habif, et al, 2012; Craythorne & Al-Niami, 2017); using the ABCDE pneumonic, asymmetry is present with the irregular borders and oblong shapes, the border is not well-defined, color is melanocytic, the nevus is dark, and the nevus has increased in size (evolved) (Craythorne & Al-Niami, 2017). Given the compounded concern of the patient’s extensive history of sun exposure and indoor tanning booths, these further paint this in a suspicious light. According to Hartnett and O’Keefe (2016), while less common than non-melanoma skin cancers (NMSCs), malignant melanoma causes the most fatalities, approximately 9,000 lives annually.
Basal cell carcinoma (BCC) is much less likely, but given this patient’s risk factors should still be ruled out. BCC is the most common NMSC and is related to chronic and frequent sun exposure, as in this patient (Craythorne & Al-Niami, 2017). While BCC is typically slow-growing, and unlikely to metastasize in the event of early diagnosis and intervention, an additional risk factor includes the patient’s age, 52 (Craythorne & Al-Niami, 2017). It is more unlikely, however, given the more common presentation as a papule with rolled edges, scabs that are not healing, or scar-like whitened areas (Craythorne & Al-Niami, 2017).
Squamous cell carcinoma (SCC) would be a third differential to consider. Buttaro, et al (2017) describe SCC lesions as “roughened, scaling area that does not heal and readily bleeds when scraped”, as well as explaining this can result in a stacked scaly appearance (p. 246). Given the scaly appearance of K.B.’s nevus, it warrants considering SCC as a possible differential. His additional risk factors include photodamaged skin and fair skin type (Craythorne, Al-Niami, 2017).
Role of History and Physical in Diagnosis
The history and physical play an instrumental role in the diagnosis of this patient. He reports a mole that has not been present since birth, and has changed in color. He reports and extensive history of exposure to sun exposure in his construction job, and having worked outside and utilized indoor tanning beds frequently as a youth. He also has a fair skin complexion. Additionally, the mole is unlike others on his body. Given the above information of risk factors, seborrheic keratosis, malignant melanoma, BCC, and SCC, all of the factors provided in his history and physical guide the practitioner in determining differentials and what to test for.
Potential Treatment Options
Prescriptions: While Balin (2018) references Eskata (40% hydrogen peroxide), AmLactin (lactic acid), and Tri-Chlor (trichloroacetic acid) as potential treatments for seborrheic keratosis, I would not try to utilize any of these until the differentials have been ruled out. The treatments would be different if a malignancy was confirmed on pathology.
Interventions/Lifestyle Changes: K.B. would benefit greatly from lifestyle changes that will minimize his exposure to ongoing UV radiation damage. Even while working his construction job, he may use sunscreen and reapply frequently, wear long sleeves, hats, sunglasses whenever possible to block UV rays from his fair skin. Hartnett and O’Keefe (2016) state, “skin cancer because of overexposure to UV radiation is analogous to lung cancer because of use of tobacco” (p. 127). Minimizing this exposure could prevent him from developing skin cancer or worsening his seborrheic keratosis, if pathology does not confirm a malignancy.
Referrals: I would refer the patient to dermatology. If I were trained and able, I may perform a punch biopsy, but it is possible dermatology would be needed to perform either a punch biopsy or excisional biopsy for pathology confirmation and removal of possible malignancy. If pathology comes back malignant instead of confirming seborrheic keratosis, a referral to an oncologist would be appropriate for the best treatment.
Follow up: Follow up would be appropriate after biopsy, for and after treatment, and routinely for skin exams given his high-risk status.
Education: The most crucial education for this patient is minimizing as much as possible his risk factors; he cannot change his age, skin type, or history, but he can minimize exposure to UV radiation and even harsh chemicals moving forward. Education on self-monitoring is important as well, given his report of other moles. It would be appropriate for him to monitor these for any possible changes as well.
Assess the Technological Solutions Available to Ameliorate Global Warming Presentation A worldwide temperature alteration has been turned out to be the immediate aftereffect of anthropogenic causes or man-made mediations with nature. Beginning with the Industrial Revolution of the late eighteenth Century, innovations have been produced that brought about the amassing of ozone depleting substances in the climate which trap the sun's brilliant vitality. This upgraded nursery impact slowly raises the world's surface temperatures and is anticipated to make sporadic natural conditions, specifically: the liquefying of polar ice tops, ascending of ocean level, significant agrarian changes coming about because of environmental change, elimination of species, strange climate conditions, expanded frequency of tropical sicknesses, vanishing of biological specialties and interruption of drinking water supply, ("Global Warming," 2004). Since a dangerous atmospheric devation offers an incredible potential to make disastrous impacts on the earth all in all, it turns into a worldwide issue, requiring the inclusion of the entire universal network in discovering approaches to improve its antagonistic impacts, (Baird, 2006). Worldwide ozone depleting substance outflows that are causing an Earth-wide temperature boost originate from various areas. Figure I underneath demonstrates the worldwide ozone harming substance outflows by segment information: Land utilize change and ranger service contribute the most astounding ozone depleting substance discharge rate (19%); trailed by power (16%); agribusiness (14%); transport (13%); other fuel burning (11%); assembling and development (10%); squander (4%); and modern (3%) and joined warmth and power (3%). The Pew Center on Global Climate Change (Undated, p. 1) affirms that "on the grounds that there are such a significant number of wellsprings of these gases, there are additionally numerous alternatives for lessening discharge." This paper assesses the accessible innovative answers for enhance a dangerous atmospheric devation by displaying the points of interest and detriments of every choice. In addition, such arrangements will be displayed on a sectoral premise, beginning with land utilize, ranger service and farming; trailed by power, lastly by the transportation area. Land Use, Forestry and Agriculture Sector Technology Land utilize and ranger service innovation incorporates carbon bookkeeping, sequestration, and biofuel creation. 1. Carbon Accounting and Sequestration As indicated by the Intergovernmental Panel on Climate Change or IPCC (2000), carbon stock upgrade from land utilize, arrive – utilize change and ranger service exercises are reversible and in this manner require cautious bookkeeping. Carbon bookkeeping innovation, which includes arrive based bookkeeping and action based bookkeeping, gives exact and straightforward information on carbon stocks as well as changes in ozone depleting substance discharges by sources and expulsions by sink. These information are required to survey consistence with the duties under the Kyoto Protocol. Additionally, carbon bookkeeping will help decide important carbon pools that can be utilized in the creation of an elective wellspring of fuel, for example, biofuels. Changes in carbon stocks can be actually decided with the utilization of movement information, remote-detecting methods, models got from factual investigation, transition estimation, soil testing and biological studies. In any case, the expense of carbon bookkeeping increments as exactness and scene heterogeneity expands, (IPCC, 2000). Because of watchful carbon bookkeeping, abundance carbon would then be able to be caught or sequestered so as to be used as fuel source. A case of carbon sequestration innovation is the Integrated Gasification and Combined Cycle Process or IGCC, which takes into consideration simple sequestration of carbon for long haul stockpiling in underground land arrangements. Nonetheless, the Pew Center on Global Climate Change (Undated), alerts that further research is expected to test the suitability of vast scale underground stockpiling of carbon in a long haul scale. 2. Biofuel Technology Biofuel generation or biomass gasification guarantees bring down ozone depleting substance emanation levels by changing over waste wood and biomass into biofuels that could supplant petroleum derivatives. The report of the Pew Center on Global Climate Change (Undated, p. 4), keeps up that horticultural terrains can be planted with carbon-dioxide settling trees that can be utilized for fuel creation. This will result to arrive utilize changes that may have different aberrant advantages, for example, enhancement of soil, air and water quality; and increment in natural life living space. In any case, think about discoveries recommend that the development of corn and soybeans for biofuel creation produces antagonistic natural effects, for example, the filtering of pesticides and nitrogen and phosphorus from composts into water assets, (Manuel, 2007). In addition, biofuels are from two to multiple times more costly than non-renewable energy sources and are not accepted to contend well in the commercial center. For instance, "a fuel – cost correlation demonstrates that while gas could be refined for 15 to 16 pennies for each liter (in the late 1980s), the expense of biofuels went from a normal of around 30 pennies for every liter (for methanol got from biomass) to 63 pennies for every liter (for ethanol got from beets in the United Kingdom)", (Barbier et al. 1991, p. 142; refered to in Johansen, 2002, p. 266). Power Sector Technology As indicated by the Pew Center on Global Climate Change Report (Undated), control plants and coal ignition that supply electric power represent the ozone depleting substance discharges on the power area. Innovative arrangements accessible for this part to address a dangerous atmospheric devation include: 1. Coordinated Gasification and Combined Cycle Process The Integrated Gasification and Combined Cycle Process or IGCC, is a power age innovation that enhances the productivity of electric power and warmth age with the utilization of a mix of petroleum derivatives and sustainable power source. It empowers clean gas generation and the decrease in carbon dioxide emanations with the utilization of superior gas turbines, (Abela, et al., 2007). Also, air poisons, for example, particulate issue, sulfur, nitrogen and mercury are expelled from the gasified coal before burning, (Abela, et al., 2007). Nonetheless, the significant burden of utilizing this innovation is its mind-boggling expense of activity, which is about 20% more than the working expense of a conventional coal plant, (Wikipedia, undated). 2. Sustainable power Sources Sustainable power sources, for example, the breeze, sun oriented and water can deliver power without discharging ozone harming substances and are in this manner vital in the improvement of an Earth-wide temperature boost. a. Wind Power Wind control innovation saddles the intensity of the breeze which is a roundabout type of sun based power, to supply vitality. Some have propeller type gadgets, while others have vertical pivot plans, which have the capacity to acknowledge twist from any heading. As per Elliott (2003), wind control is as of now a basic wellspring of vitality; and that in 2002, the aggregate producing limit has achieved 24,000 megawatts, with costs diminishing essentially with innovation improvement. Be that as it may, this innovation regularly has substantial space prerequisites, because of the need of the breeze turbines to be gathered together in twist ranches, so as to encourage sharing of associations with the power framework. Additionally, there ought to be a detachment of around 5 to 15 cutting edge breadths between individual breeze turbines, so as to "counteract tempestuous communications in wind cultivate exhibits" , (Elliott, 2003, p. 135). b. Sunlight based Power Brilliant vitality can be caught and used to produce power which might be utilized to work sunlight based batteries or might be transmitted along ordinary transmission lines. Brilliant vitality is gathered in a photovoltaic cell, which is a bimetallic unit that enables guide change of daylight to power. The main downside of using photovoltaic cells is its surprising expense. Be that as it may, later "improvements in the semiconductor business have altogether cut down costs", (Elliott, 2003, p.132). Electric power age has likewise been cultivated with the utilization of enormous sun based warmth concentrating mirrors and explanatory troughs and dishes that track the sun over the sky and center its beams in order to raise steam, (Elliott, 2003, p130), and subsequently deliver power. One noteworthy hindrance of utilizing sun powered power innovation is that it works just amid the day and requires electrical capacity instruments during the evening. Furthermore, brilliant warmth is inadequate in chilly districts and in regions with broad shady periods, bringing about low measure of vitality accumulation. c. Water Power Hydropower is the world's greatest sustainable wellspring of vitality. It is esteemed as a standout amongst the most worthy and cleanest advancements whereby a unit of water produces hydropower aggregately by going through the turbines of numerous dams along the plummet of a waterway", (Gibbons, 1986, p. 86). As per Elliott (2003, p. 151), "there is around 650 GW of introduced limit set up, for the most part in 300 expansive activities. Notwithstanding, as of late, there have been social and ecological worries about vast hydros, and some new undertakings have met with resistance". Its unfriendly ecological effects incorporate the demolition of expansive zones of regular vegetation and rural land for water stockpiling; biodiversity misfortune, flooding and uprooting of populace, (Elliott, 2003). 3. Geothermal Power Geothermal power isn't viewed as a sustainable asset when utilized at rates of extraction more prominent than their normal renewal. With economical utilize, in any case, geothermal power can be adequately tackled to give power. Geothermal vitality originates from the warmth of the earth and can be arranged into geopressured, magma, aqueous and hot dry shake, (Wright, 2002, p. 362). As indicated by Hobbs (1995, refered to in Wright, 2002, p. 362), business activities are generally as aqueous frameworks "where wells are around 2000 meters deep with supply temperatures of 180 to 270°C." Although geothermal frameworks deliver less t>GET ANSWER