Patient C

Patient is a 32-year-old female who comes in today because of concerns regarding excessively dry skin of her face as well as overall concerns regarding skin cancer. The patient states that she has noticed that in particular in the morning when she gets out of the shower her face is very red, almost of the extent of being painful. She also notices a lot of dry and flaking of her skin. She does feel this has gradually gotten better as she has started to use Clinique moisturizing lotion. In addition to this, she does use an SPF 25 on her face on a daily basis. She is wondering whether this problem with dryness of her skin and redness puts her at increased risk for skin cancer. She is almost interested in management strategies for this.

With respect to concerns about skin cancer, she has had frequent sunburns growing up and did not wear sunscreen when she was younger. Currently she has tried to do this more regularly. On the weekend she places waterproof 15 to 30 sunblock across all of her body. During the weekdays, she is indoors most of the day as she works, and she does use continuous SPF on her face. She has no moles that she is currently concerned about except a small one on her leg. She patient does not use any drying soaps on her face and has not used any new shampoos recently.

On physical exam, in general, this is a pleasant female in no acute distress. Her blood pressure today is 112/78, pulse is 76. Looking at the spot on her left thigh, this is approximately a 3 mm brown, slightly triangular appearing mole, which is flat and even. Color is uniform and borders are regular.

ASSESSMENT & PLAN:

1)Regular nevi. The patient was reassured regarding this.

2)Dry skin. The patient and I did go through some general care regarding this. As it seems she ahs found a moisturizer that works for her, I have encouraged that she continue to use it.

3)Skin cancer prevention. The patient and I went through in detail how to conduct regular self skin checks. She was given pamphlets on these. We did go over the ABCDs of melanoma as well as other types of skin lesions, to look for. I did ask her to contact us if she has any concerns.

Please note that 25 minutes was spent with this patient and over 50% of the time was spent on counseling.