# data[].attributes.body
1. Caucasian male- European with light skin pigmentation
2. Cutaneous lump- Any area with abnormality skin. It can be benign or malignant
3. Lump- Abnormal mass or swollen
4.Former- Occurring in the past

# data[].attributes.body
1. 66-year old Caucasian male
2. Cutaneous lump
3. Former gardener
4. 1 year history
5. back of his neck

# data[].attributes.body
TRIGGER 1
1.Caucasian male
-White people are more prone to skin disease (less melanin)
-Less melanin exposed the host to more sun damage (UV radiation)
- Male are easier to develop basal or squamous cell carcinoma and also more likely develop melanoma after age 50

2. Age (66 years old)
-Elderly age so he is immuno-compromised
-More prone to get disease
-Have a higher risk of cancer

3. Former gardener
-As a former gardener he is exposed to a more soil and water contaminated environment (favourable condition for bacterial growth)
-Might also be exposed to chemical substance
-He is always exposed to UV light as a gardener, this damages the DNA in our skin (skin cancer)

4. 1-yr history
-Indicates it is a long period (Chronic disease)

5. Cutaneous lumps on the back of his neck
-Can be caused by swollen nodes (indicates infection)
-May also indicate lipoma which is a benign growth under the skin
- May be caused by blocked glands (leads to hormonal changes)
-Common cause might be swelling from injury
-The lump can be papillomatous growth which can be due to Sun damage and smoking
-The lumps can be neoplasm so it can be benign or malignant

DIFFERENTIAL DIAGNOSIS
-Skin tag (benign)
-Bacterial infection
-Melanoma (exposed to UV light)
-Skin cancer
-Sebaceous cyst
-Head and neck cancer
-Lipoma

FURTHER QUESTIONING
-Does he covers his head during gardening?
-Does he smoke,drink or do drugs? (social history)
-Ask about his family disease history
-Whether he received any medical attention during the swelling period
-Does he have any past medical history? (HIV, CHRONIC DISEASE)
-Did he had any physical injury?
-Did the lump increased or decreased in size during the 1 yr period?
-Ask symptoms that he have. (Fever, weight loss, pain or tender, itchiness, fatigue)
-Appearance of the swelling
-Lump is firm or soft
-How fast it has grown?
-Colour of the lump
-What is he gardening and the chemical substance in use?
-Any other lumps around the body?

# data[].attributes.body
1. Immunosupressant - it is a type of drug that inhibit or block the immune response
2. Corneal graft rejection - sequence of immune response involve the recognization of foreign histocompability antigen
3. Keratinoplasty - corneal transplant
4. Drug abuse - the use of certain chemical for non-medicinal reason
5. Hereditary- genetically-transmitted
6. Graft - healthy tissue taken from one part of the body and used to replace disease tissue remove from other part of the body
7. Corneal - the clear front window of the eye that transmit and focus light into the eye
8. Medical illness - an abnormal condition of a part, organ, or system of an organism resulting from various causes

# data[].attributes.body
1. Rapidly growing lump
2. Lump reached that size within 3 months
3. His mother died of skin cancer
4. Was neglected for much longer
5. He moved from UK to Australia
6. Received immunosupressant to prevent corneal graft rejection
7. Smoking history of 20 years
8. No history of medical illness, alcohol, and drug abuse
9. He had keratoplasty

# data[].attributes.body
1. Rapidly growing lump
- Can be malignant
- Has the ability to proliferate
- Aggresive lymphoma causes by the infection from lymph nodes
- May be a cyst (most are non-cancerous, grow rapidly,, caused by infections, tumors, parasites and injuries)
- Malignant usually solid mass of tissue, while cyst is a sac of capsule that is filled with fluid or air
- Can be melanoma (a type of skin cancer, some melanoma can grow fast but also might slowly get bigger over years, it can start to grow down into deeper layer of the skin and may form lumps)
2. Negleted for much longer
- Neglected because the lump is not painful (may also indicate benign tumour)
3. Moved to Australia from UK
- Country that get one of the highest amount of UV exposure
- Australia has the highest amount of skin cancer per year (more likely to get skin cancer)
4. Received immunosupressants
- Decrease the body's ability to fight against infection and other diseases such as cancer (increase the risk of developing cancer)
5. His mother died of cancer associated with a hereditary skin condition
- Has the possibility of developing skin cancer from the mother
- He might have mutated gene from germline mutation
- The mutation occurs at X chromosome
6. Smoking about 20 ciggaretes per day for the past 20 years
- Contain tobacco (carcinogenic) weakens the body immune system, making it harder to kill cancer cells
- Carcinogenic means that it increases the possibility of developing cancer

DIFFERENTIAL DIAGNOSIS
1. Skin cancer (specifically melanoma)
2. Injury should be ruled out
3. Sebaceous cyst can be removed
4. Malignant lymph nodes (leukemia or lymphoma or metastases)
5. Bacterial infection

FURTHER QUESTIONING
1. Request for a Full Blood Count test
2. Biopsy diagnosis of the lump
3. Vital signs include blood pressure, pulse rate, respiratory rate, and temperature
4. Request for CT scan (for his whole body - his tumor may metastasize) or MRI scan
5. Biochemical test - SCC antigen tumor marker test

# data[].attributes.body
1. protuding-sticking out of surface
2.foul-smell-unpleasent smell(extremely)
3.inspection-to look at the body part
4.cauliflower-like-shape of the lump which resemble broccoli
5.necrotic-cell death,unplanned
6.erythematous skin-redness of skin by injury
7.ulcerated-become effected with ulcer

# data[].attributes.body
1. vital sign are normal
2. necrotic
3. cauliflower firm mass
4. ulcerated
5. protruding
6.size of lump 4 time 3 cm
7.foul-smelling
8.firm mass develop over a large erythematous skin area
9.other system reviews revealed no abnormality

# data[].attributes.body
1.vital sign normal
-no fever indicates no infection
protruding ulcerated necrotic foul-smelling cauliflower-like firm mass
-indicates ulcer cancer,develop from skin cancer such as melanoma
-ca be giant squamous cell carcinoma (malignant)
3.necrotic
-support diagnosis malignant tumor
-occur when cancer cell invades the epithelium and penetrates epidermis
protruding
-raise growth which is one of prominent appearance of skin cancer
4.size of lump
-large,squamous cell carcinoma can growth huge size
5.develop over large erythematous skin
-dilation of superficial blood vessel in the skin
6. ulcerated
-firm mass grows to the point that it breaks through the skin
7. erythematous skin
-redness because of UV radiation
- leads to cancer

differential diagnosis
1.skin cancer

further questioning
1.grade and stage of the cancer
-biopsy

# data[].attributes.body
1.  Infiltrate- the cancer cell grows into surrounding healthy tissue.
2. Metastasis-development of secondary malignant growth at a distant from a primary site of cancer
3. re-epithelisation- it is a coordinated multi factorial process that involves formation new epithelium and skin appendages.
4. subjacent tissue- deeper tissue
5. perineural invasion- tumour cell touching or invading nerve.
6. clear margin- no cancer cells at the outer edge of the tissue that was removed.
7. GENERAL ANASTHESIA- combination of medications that put you in a sleep like state before a surgery.
8. excised-been cut out
9. approximate- bring close together.
10. lymphovascular invasion- involvement of small lymphatic or blood vessels by tumour.
11. well differentiated- cancer cell is resemble to normal cells (grade 1)
12. histological examination- the examination of tissue under a microscope.

# data[].attributes.body
1. Full blood count normal
2. CT scan show the tumour had not infiltrated deep into the subjacent tissue
3. No lymph node or distant metastases.
4. Tumour infiltrated the subcutaneous tissue can be seen after surgery.
5. After surgery, surrounding skin could not be aprroximated.
6. Histological examination revealed well differentiated- squamous cell carinoma.

# data[].attributes.body
Prob. associated question
1. Full blood count is normal
- no inflammation/no infection (confirm)
2. Infiltration in the subcutaneous tissue but no lymph node & distant metastases.
-it indicates stage 1.
3. Well differentiated
-indicates grade 1

DIFFERENTIAL DIAGNOSIS
1. Squamous cell carcinoma.
2. It's not benign but a malignant tumour.