Leonard's changing mole: skin integrity case study
Every detail in this case is a risk factor placed deliberately: forty years outdoors, a mole that changed, bled and is now moist, and a father who went into the barn at midday while Leonard stayed in the sun.
Editorial process
Last reviewed · August 15, 2026
The occupational history is the clinical clue
Read the case as an accumulation of risk rather than as a story. Leonard is sixty, has spent a working life outdoors in agriculture, and the exposure described is chronic and cumulative rather than intermittent — which matters, because different ultraviolet exposure patterns are associated with different skin cancers. The lesion itself carries several of the classic warning features at once: it has changed, which is the single most important sign; it is darker, which is variation in colour; it is moist and has bled, which indicates loss of surface integrity; and there is surrounding erythema. Apply a recognised framework rather than listing what you notice — asymmetry, border irregularity, colour variation, diameter and evolution — and say explicitly that evolution is the feature the wife actually observed and the one that should trigger referral regardless of the others. A lesion meeting no other criterion but changing is still a lesion for excision.
Then the mechanism, which is what turns a description into pathophysiology. Ultraviolet radiation damages DNA directly, producing pyrimidine dimers, and indirectly through reactive oxygen species; repair capacity falls with age and accumulated damage; and when mutations affect the genes controlling melanocyte proliferation and apoptosis, unregulated growth follows. Bleeding and moisture indicate that the lesion has breached the epidermis, which is a staging concern rather than merely a cosmetic one, since depth of invasion is the strongest predictor of outcome. Cover the diagnostic pathway — dermoscopy, then excisional biopsy rather than shave, because depth must be measurable — and the reason a punch biopsy through the middle of a pigmented lesion is the wrong choice. Finally use the detail the case supplies about Leonard's father: he took shade at the hottest part of the day and Leonard did not, which is exactly the prevention message, and it lets you close on occupational sun protection rather than on generic advice.
Likely learning objectives
Inferred from the brief — check these against your own rubric.
- 01Identify cumulative occupational ultraviolet exposure as a distinct risk pattern.
- 02Apply a recognised lesion assessment framework rather than describing impressions.
- 03Explain ultraviolet-induced DNA damage and its progression to unregulated growth.
- 04Justify excisional biopsy by reference to depth of invasion as a prognostic factor.
Read the full question
Review every instruction before using the planning guidance that follows.
Course-wide instructions that accompany this question
Important information for writing discussion questions and participation Hi Class, Assignment Disorders of Skin Integrity and Function Please read through the following information on writing a Discussion question response and participation posts. Contact me if you have any questions. Important information on Writing a Discussion Question Your response needs to be a minimum of 150 words (not including your list of references) There needs to be at least TWO references with ONE being a peer reviewed professional journal article. Include in-text citations in your response Do not include quotes—instead summarize and paraphrase the information Follow APA-7th edition Points will be deducted if the above is not followed Participation –replies to your classmates or instructor A minimum of 6 responses per week, on at least 3 days of the week. 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I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!
Turn the brief into deliverables
- 01Leonard's risk factors, drawn from the case's own details.
- 02An assessment of the lesion against a recognised framework.
- 03The pathophysiological mechanism from exposure to lesion.
- 04The diagnostic pathway with a justification for the biopsy technique.
- 05Prevention advice tied to the case, with APA citations.
Risk, lesion, mechanism, then prevention
Risk from the history
Assemble age, occupation, cumulative exposure and the behavioural contrast with his father.
Assess the lesion
Apply the recognised framework and identify which features are present.
Pathophysiology
Trace ultraviolet DNA damage, failed repair and unregulated melanocyte growth.
Diagnosis
Set out dermoscopy and excisional biopsy, and why depth must be preserved.
Prevention
Use the father-and-son contrast to frame occupational sun protection.
Sources on melanoma and photodamage
Recommended databases
- NCBI Bookshelf (StatPearls)
- American Academy of Dermatology
- American Cancer Society
- PubMed Central
Search sequence
- 1.Fix the assessment framework from a professional-body source so the criteria are stated correctly.
- 2.Read the guideline-based management chapter for the diagnostic pathway and biopsy rationale.
- 3.Search for occupational ultraviolet exposure in agricultural workers, which is Leonard's specific risk group.
- 4.Check current staging language before commenting on prognosis, since it has been revised.
Reference shortlist
These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.
Nothing here is cleared for citation until you have read it.
- 01
Cutaneous Malignant Melanoma: Guideline-Based Management
StatPearls, NCBI Bookshelf · 2023
Guideline-based management including the biopsy approach and why depth of invasion governs prognosis.
- 02
What to look for: ABCDEs of melanoma
American Academy of Dermatology · 2024
The professional-body statement of the assessment framework, in the form the case should be judged against.
- 03
Melanoma Skin Cancer | Understanding Melanoma
American Cancer Society · 2024
Risk factors, presentation and staging in accessible form, useful for the prevention section.
- 04
Pressure Injury
StatPearls, NCBI Bookshelf · 2023
Skin integrity and wound considerations, relevant to the breached, bleeding surface described in the case.
Review before submission
Common mistakes
- Describing the lesion without applying an assessment framework.
- Missing that change over time is the most significant single feature.
- Recommending a shave biopsy, which destroys the depth measurement prognosis depends on.
- Explaining ultraviolet damage without reaching the cellular mechanism.
- Giving generic sun advice instead of using the father-and-son contrast the case supplies.
Submission checklist
- Have you used the occupational history as a risk factor rather than as background?
- Is the lesion assessed against a named framework?
- Does the mechanism reach DNA damage and unregulated proliferation?
- Have you justified the biopsy technique by depth?
- Is the prevention advice tied to Leonard's own working pattern?
Use this guide to plan and review your own work. Follow your institution's rules and read our academic-integrity policy.
Written by
Aaron Bishop
MA, Education
assignment interpretation and research-methods coaching across disciplines
Aaron leads the EssayCrackers editorial desk. He works on how assignment briefs are read — what a rubric is actually asking for, and where students most often answer a different question than the one set.
Reviewed by
Dr. Nathan Cole
PhD, Rhetoric & Composition
Argumentation and thesis development
Nathan teaches first-year composition and directs a university writing center. He reviews EssayCrackers guides for argumentative soundness and citation accuracy.