[Expert Solution]: Chief Complaint: “I’m here for my routine…

Chief Complaint: “I’m here for my routine physical but I have a spot on my back that I’d like the nurse practitioner to look at.” History of Present Illness: A 61-year-old Caucasian female presents to the community health clinic for a routine physical examination. During the exam, she asks you to look at a “spot” on her back that has been present “for years”. Reports lesion occasionally itches and sometimes bleeds after scratching. She is unsure if she has noticed a change in the size or color. States it is difficult to visualize due to the location on her back. Not painful or itchy. What additional (subjective data) questions would you like to ask about her review of systems and health history? Subjective Data Review of Systems, Past Medical & Social/Family History, and Medications Review of Systems: Denies fever, nausea/vomiting, night sweats, weight loss or weight gains. denies enlarged or painful lymph nodes or red rashes. Past Medical History: Reports sunbathing as a teenager. Reports she wears sunscreen “sometimes”. Denies tanning bed use. Reports she does sunburn easily and is described as having “fair skin”. Medical History: HTN, Anxiety, Solar Lentigines to bilateral upper extremities Denies tobacco, alcohol, or illicit drug use. Denies any environmental or drug allergies. Current medications: Lisinopril 10 mg daily, Lexapro 10 mg daily Family and Social History: Father MI age 78; Mother alive HTN, CVA, Hx of squamous cell carcinoma; 1 brother age 62, 1 sister age 58, both alive and well Lives with spouse, retired landscape designer; Spends much of her time outdoors; Enjoys gardening and travel States she feels “great” and has no other concerns. Risk Factors and Examination What risk factors does this patient have for skin cancers? Describe techniques of the skin examination and characteristics of the lesion that should be assessed.