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Assignment NR 602 Vascular and Pigmented Nevi Soap Note

Assignment: NR 602 Vascular and Pigmented Nevi Soap Note

Port wine stains (Nevus flammeus), Salmon Patches, Café au lait Spots, & Hemangioma

NR 602 Vascular and Pigmented Nevi Soap Note

Nevi are a common finding in children. The two most common types are vascular nevi (vascular malformations and hemangiomas) and pigmented nevi (e.g., mongolian spots, café au lait spots, acquired melanocytic nevi, atypical nevi, and lentigines).

Vascular nevi are caused by a structural abnormality (malformations) or by an overgrowth of blood vessels (hemangiomas) and are flat, raised, or cavernous. Flat lesions or vascular malformations include salmon patches (also called macular stains), an innocent malformation that is a light red macule appearing on the nape of the neck, upper eyelids, and glabella. Approximately 60% to 70% of newborns have a salmon patch on the back of the neck. Port-wine stains occur in 0.2% to 0.3% of newborns (Cohen, 2013). At 1 year old, 10% to 12% of Caucasian infants have a hemangioma—females three times more likely than males. There is also an increased incidence of hemangioma in premature neonates. Vascular malformations are always present at birth and do not resolve spontaneously. Precursor lesions of hemangiomas are present at birth 50% of the time. They undergo rapid growth (proliferative stage), stability (plateau phase), and regression (involution phase); 90% are completely resolved in children 9 to 10 years old (Paller and Mancini, 2011).

Pigmented nevi are caused by an overgrowth of pigment cells. Pigmented nevi most commonly seen are mongolian spots (found in up to 90% of African Americans, 62% to 86% of Asians, 70% of Hispanics, and less than 10% of Caucasians), café au lait spots (found in up to 33% of normal children and in 50% of patients with McCune-Albright syndrome), and acquired melanocytic nevi, the most common tumor of childhood. Atypical nevi, also called dysplastic nevi, are potential precursors for malignant melanoma. Dysplastic nevi are uncommon under 18 years old but have a higher incidence in melanoma-prone families (Paller and Mancini, 2011).

NR 602 Vascular and Pigmented Nevi Soap Note

Clinical Findings

  • Presence from birth, or age first noted
  • Progression of lesion
  • Familial tendencies for similar nevi, especially for history of melanoma


Physical Examination

Findings include the following (Box 37-8):

  • Vascular malformations or flat vascular nevi are present at birth and grow commensurate with the child’s growth.
  • Hemangiomas are classified as superficial, deep (cavernous), or mixed. They may or may not be present at birth, but they usually emerge by 2 to 3 weeks of life. They may manifest initially as a pale macule, a telangiectatic lesion, or a bright red nodular papule. After appearing, hemangiomas go through a proliferative phase during which they grow rapidly and form nodular compressible masses, ranging in size from a few millimeters to several centimeters. Occasionally they may cover an entire limb, resulting in asymmetric limb growth. Rapidly growing lesions may ulcerate. The final phase of involution occurs slowly (10% per year) but spontaneously (30% by 3 years old, 50% by 5 years old, 70% by 7 years old, and 90% by 9 to 10 years old). Average involution begins between 12 and 24 months old, heralded by gray areas in the lesion followed by flattening from the center outward. Most hemangiomas appear as normal skin after involution, but others may have residual changes, such as telangiectasias, atrophy, fibrofatty residue, and scarring (Paller and Mancini, 2011).
  • Pigmented nevi may be present at birth or acquired during childhood.
  • Atypical nevi are larger than acquired nevi; have ir­regular, poorly defined borders; and have variable pigmentation.

**Common Vascular and Pigmented Lesions ***

  1. Vascular malformations or flat vascular nevi
  2. Salmon patch or nevus flammeus: Light pink macule of varying size and configuration. Commonly seen on the glabella, back of neck, forehead, or upper eyelids.
  3. B.Port-wine stain: Purple-red macules that occur unilaterally and tend to be large. Usually occur on face, occiput, or neck, although they may be on extremities.
  4. Hemangiomas
  5. Superficial (strawberry) hemangiomas are found in the upper dermis of the skin and account for the majority of hemangiomas.
  6. Deep cavernous hemangiomas are found in the subcutaneous and hypodermal layers of the skin; although similar to superficial hemangiomas, there is a blue tinge to their appearance. With pressure, there is blanching and a feeling of a soft, compressible tumor. Variable in size, they can occur in places other than skin.
  7. Mixed hemangiomas have attributes of both superficial and deep hemangiomas.

III. Pigmented nevi

  1. Mongolian spots: Blue or slate-gray, irregular, variably sized macules. Common in the presacral or lumbosacral area of dark-skinned infants; also on the upper back, shoulders, and extremities. The majority of the pigment fades as the child gets older and the skin darkens. Solitary or multiple, often covering a large area.
  2. Café au lait spots: Tan to light brown macules found anywhere on the skin; oval or irregular shape; increase in number with age.
    Assignment NR 602 Vascular and Pigmented Nevi Soap Note

    Assignment NR 602 Vascular and Pigmented Nevi Soap Note

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  3. Acquired melanocytic nevi are benign, light brown to dark brown to black, flat, or slightly raised, occurring anywhere on the body, especially on sun-exposed areas above the waist.
  4. Junctional nevi represent the initial stage, with tiny, hairless, light brown to black macules.
  5. Compound nevi—a few junctional nevi progress to more elevated, warty, or smooth lesions with hair.
  6. Dermal nevi are the adult form, dome shaped with coarse hair.
  7. Atypical nevi usually appear at puberty, have irregular borders, variegated pigmentation, are larger than normal nevi (6 to 15 mm); usually found on trunk, feet, scalp, and buttocks.
  8. Halo nevi appear in late childhood with an area of depigmentation around a pigmented nevus, usually on trunk (seeFig. 37-34).
  9. Acanthosis nigricans is velvety brown rows of hyperpigmentation in irregular folds of skin, usually the neck and axilla; tags may also be present.
  10. Lentigines are small brown to black macules 1 to 2 mm in size appearing anywhere on the body in school-age children.
  11. Freckles: 1 to 5 mm light brown, pigmented macules in sun-exposed areas.

NR 602 Vascular and Pigmented Nevi Soap Note

Verruca vulgaris

Common warts (verruca vulgaris) are usually elevated flesh-colored single papules with scaly, irregular surfaces and occasionally black pinpoints, which are thrombosed blood vessels. They are usually asymptomatic and multiple and are found anywhere on the body, although most commonly on the hands, nails, and feet. They may be dome shaped, filiform, or exophytic (Fig. 37-19). Filiform warts project from the skin on a narrow stalk and are usually seen on the face, lips, nose, eyelids, or neck. Periungual warts are common, occurring around the cuticles of the fingers or toes.

Important information for writing discussion questions and participation

Hi Class,

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.
  • Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
  • Each response needs to be at least 75 words in length (does not include your list of references)
  • Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
  • Follow APA 7th edition
  • Points will be deducted if the above is not followed

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to.

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

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!

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