NURS 6512 Week 5 Skin Lesion Write-Up Example

Course	NURS 6512 Advanced Health Assessment and Diagnostic Reasoning
Week	Week 5
Paper type	Skin lesion differential write-up
Length	About 1,170 words, 7 pages
Format	APA 7 student paper
School	Walden University
Program	Master of Science in Nursing (MSN)
Updated	October 2026

Free sample paper for NURS 6512 Week 5

A Changing Pigmented Lesion on the Upper Back of a 58-Year-Old Man: Morphology, ABCDE Assessment, and a Ranked Differential

Student Name

College of Nursing, Walden University

NURS 6512: Advanced Health Assessment and Diagnostic Reasoning

Instructor Name

Month Day, Year

What this page is doingThe title names the finding that drives the case (a lesion that has changed) and the three things the paper will do with it. It stops short of naming a diagnosis, which would signal that the reasoning was settled before the examination was recorded.

A Changing Pigmented Lesion on the Upper Back of a 58-Year-Old Man: Morphology, ABCDE Assessment, and a Ranked Differential

Subjective

R.T., whose case was invented for this exercise, is a 58-year-old man who presents at his partner's urging because a "mole" on his upper back "looks different than it used to." He cannot see the area himself. His partner first noticed it roughly four months ago during the summer and believes it has grown and darkened unevenly since then. The patient reports occasional itching over the spot for about three weeks. He denies bleeding, crusting, ulceration, or pain, and he has not noticed any new lumps in his neck or armpits.

His sun history is substantial. He worked outdoors as a surveyor for 26 years, usually without sunscreen or a shirt in hot weather, and he recalls at least five blistering sunburns before age 20. He has never used a tanning bed. He had a basal cell carcinoma removed from his nose eight years ago and has not had a full-skin examination since. His father was diagnosed with melanoma of the calf at age 70. He takes lisinopril 10 mg daily for hypertension and no immunosuppressive medication, and he has no known drug allergies. He does not smoke. A focused review of systems is negative for weight loss, fatigue, night sweats, headache, cough, and bone pain.

What this page is doingThe history is chosen for risk, not completeness. Change reported by a second observer, cumulative and blistering sun exposure, a prior skin cancer, and a first-degree relative with melanoma are the items that move the differential, so each is recorded with specifics. The systemic negatives at the end are not filler; they are the screen for metastatic disease that a changing lesion obliges the examiner to document.

Objective

Vital signs are within normal limits. Skin type is Fitzpatrick II, with fair skin and light brown hair. On the left upper back, 6 cm lateral to the spine at the level of the scapular spine, there is a single macule with a slightly raised central papular component measuring 9 mm by 7 mm. The shape is asymmetric in both axes. The border is irregular, with a notched inferior edge and an indistinct superior edge where pigment fades into surrounding skin. Color is variegated, with dark brown, black, and a gray-blue area in the lower third and a pink-red area at the upper margin. The surface is smooth over most of the lesion; there is no scale, crust, erosion, or ulceration. No satellite lesions are present within 2 cm.

A total-skin survey was performed with the patient fully undressed. He has 34 other melanocytic nevi, all between 2 and 5 mm, uniformly tan to medium brown, round to oval, with regular borders. Numerous solar lentigines are present across the shoulders and forearms, and there are three stuck-on, waxy, light brown papules on the trunk with a verrucous surface. The lesion on the left upper back differs clearly from every other nevus on his skin in size, color, and border. The scar from the prior nasal excision is well healed without recurrence. Cervical, supraclavicular, and axillary lymph nodes are not palpable. The liver edge is not palpable below the costal margin.

What this page is doingNo diagnostic word appears in this section. The lesion is described in the order a dermatologic description conventionally follows (type, size, shape, border, color, surface, surroundings) so a reader could picture it without the photograph. The total-skin survey then does something the rubric rewards: it compares the lesion with the patient's other nevi, which is the basis of the ugly duckling sign used later.

ABCDE Assessment

Each feature of the ABCDE framework is applied separately, since the framework is only useful when every element is checked (Abbasi et al., 2004). Asymmetry is present: the lesion does not match itself when bisected along either axis. Border irregularity is present, with notching inferiorly and a blurred margin superiorly. Color variegation is present, with at least four colors, including gray-blue and red, which are less typical of benign nevi. Diameter exceeds 6 mm at 9 mm, although this criterion alone is weak because early melanomas can be smaller. Evolution is present by history: a change in size and color noticed by his partner over four months, with new itching. The lesion meets all five criteria. It is also an outlier among his own nevi, the ugly duckling sign described by Grob and Bonerandi (1998), which adds weight independent of the ABCDE count.

Assessment: Differential Diagnosis

The five candidates are ranked on two axes: how likely each is given the findings, and how costly it would be to miss. The ranking below places danger first where the two conflict.

1. Melanoma, superficial spreading type. Supporting: all five ABCDE features, evolution reported by a reliable observer, color including gray-blue and red, the ugly duckling sign, a location on the upper back typical for men, extensive intermittent sun exposure with blistering burns, a prior keratinocyte carcinoma, and a father with melanoma. Against: no ulceration or bleeding and no palpable nodes, which argue only against advanced disease, not against melanoma itself. This is the leading diagnosis on both likelihood and consequence.

2. Dysplastic (atypical) nevus. Supporting: asymmetry, irregular border, and diameter over 6 mm are common in atypical nevi. Against: the lesion is a single outlier rather than one of several similar atypical nevi, and the recent change with gray-blue color and a pink margin is less typical. It stays second because only histology separates it reliably from early melanoma.

3. Pigmented basal cell carcinoma. Supporting: his prior basal cell carcinoma and chronic sun exposure, and some pigmented basal cell carcinomas show blue-gray color. Against: no pearly translucent rolled border, no telangiectasia, and no ulceration, and the lesion is largely flat rather than nodular.

4. Seborrheic keratosis. Supporting: his age and the presence of three seborrheic keratoses elsewhere; irritated seborrheic keratoses can itch and darken. Against: this lesion lacks the waxy, stuck-on, verrucous surface of his other keratoses, and its border blurs into the surrounding skin rather than sitting sharply on top of it.

5. Solar lentigo. Supporting: extensive sun damage and numerous lentigines on his shoulders. Against: lentigines are uniformly colored, flat, and stable, and this lesion is variegated, partly raised, and changing. It is included for completeness and ranked last on both axes.

What this page is doingThis is the longest section and where most marks are awarded. Each diagnosis carries findings for and against it, taken from the history and examination already recorded, and the paper states openly that ranking is done on likelihood and on the cost of missing each one. A list of five names with no evidence attached would read as recall; this reads as reasoning a grader can check line by line.

Plan: The Step That Separates the Top Two

Melanoma and dysplastic nevus cannot be separated reliably on clinical grounds, so the next step is tissue. Dermoscopy in the clinic can strengthen or weaken suspicion but does not replace histology for a lesion with this profile. Current guidelines recommend a narrow excisional biopsy with 1 to 3 mm clinical margins that removes the entire lesion, so that the pathologist can assess the full depth; wide excision is deferred until the diagnosis and Breslow thickness are known (Swetter et al., 2019). A shave biopsy that transects the base would risk underestimating thickness and is avoided. Biopsy is arranged within two weeks, the patient and his partner are told directly that the lesion is concerning and why, and the conversation includes sun protection and the value of his partner's continued observation. Given his personal history of skin cancer and his father's melanoma, he will need a total-skin examination at regular intervals regardless of the result (Ball et al., 2023). If pathology confirms melanoma, staging and referral decisions will follow from Breslow thickness, ulceration, and mitotic findings on the report, and the plan will be rewritten around them; if it shows a dysplastic nevus, the degree of atypia and the status of the margins will decide whether any further excision is needed. Either way, the follow-up visit is booked before he leaves, since a result that no one reviews with the patient is a gap in the plan rather than a detail.

References

Abbasi, N. R., Shaw, H. M., Rigel, D. S., Friedman, R. J., McCarthy, W. H., Osman, I., Kopf, A. W., & Polsky, D. (2004). Early diagnosis of cutaneous melanoma: Revisiting the ABCD criteria. JAMA, 292(22), 2771-2776. https://doi.org/10.1001/jama.292.22.2771

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2023). Seidel's guide to physical examination: An interprofessional approach (10th ed.). Elsevier.

Grob, J. J., & Bonerandi, J. J. (1998). The 'ugly duckling' sign: Identification of the common characteristics of nevi in an individual as a basis for melanoma screening. Archives of Dermatology, 134(1), 103-104. https://doi.org/10.1001/archderm.134.1.103-a

Swetter, S. M., Tsao, H., Bichakjian, C. K., Curiel-Lewandrowski, C., Elder, D. E., Gershenwald, J. E., Guild, V., Grant-Kels, J. M., Halpern, A. C., Johnson, T. M., Sober, A. J., Thompson, J. A., Wisco, O. J., Wyatt, S., Hu, S., & Lamina, T. (2019). Guidelines of care for the management of primary cutaneous melanoma. Journal of the American Academy of Dermatology, 80(1), 208-250. https://doi.org/10.1016/j.jaad.2018.08.055

Reading the NURS 6512 Week 5 instructions

Week 5 of NURS 6512 asks for a write-up of a skin lesion with a differential. Document subjective and objective findings, describe the lesion morphologically, apply a structured tool and rank differentials with reasons. Vague morphology is the most common loss, so give size in millimeters, color, border, surface and distribution. Cite assessment sources in APA 7. Diagnostic words stay out of the examination because they replace description with conclusion. The write-up ranks melanoma first but does not conclude it; biopsy decides. An image supplied by the prompt can serve as the objective source. A clear layout follows subjective, objective, ABCDE, differential and plan, with the lesion description written before any interpretation.

Inside the NURS 6512 Week 5 example

A focused write-up of about three pages. The history dates the change as the patient and his partner report it and covers sun exposure, prior skin cancer, family history of melanoma, and any itching or bleeding. The examination describes the lesion in standard dermatologic terms, primary lesion type, size, shape, border, color variation, surface, distribution and any secondary change, then records a total-skin survey for similar or atypical lesions. The ABCDE features are applied one at a time. The differential lists melanoma, dysplastic nevus, seborrheic keratosis, pigmented basal cell carcinoma and solar lentigo, each paired with the findings for it and against it, ranked by both likelihood and consequence. A closing line names the diagnostic step that would separate the top two. His partner, like him, is invented.

NURS 6512 Week 5 rubric: what earns full marks

The most common loss in skin write-ups at this level is vague morphology. A lesion described as a dark mole of some size gives a grader nothing to reason from, and the examination criteria usually expect standard terminology throughout. Diagnostic words slipping into the examination, calling a lesion suspicious or benign-appearing before the differential, are the next frequent deduction. Differentials listing five diagnoses without findings for and against each read as recall. The ABCDE features are often invoked but not applied individually, which forfeits the points attached to the framework. Skipping the survey of other lesions draws comment, as does a differential ranked by likelihood alone with no attention to what would be dangerous to miss. A current dermatology source behind the differential supports the evidence line.

Common NURS 6512 Week 5 mistakes, and how to avoid them

Skin write-ups score poorly when the lesion is called a dark mole. Measure and describe it. A second weakness is diagnostic words in the exam section. Keep them for the assessment. Writers also rank differentials without reasons. Link each to findings. Avoid concluding melanoma without tissue. Name the deciding test. Record sun history. A description such as a 9 by 7 millimeter macule with irregular notched border and two shades of brown gives a reader something to reason from. Close with the step that settles the top two.

Get a NURS 6512 Week 5 example written to your instructions

Upload the Week 5 prompt and rubric together with any case narrative or image descriptions, and a lesion write-up returns written in standard morphologic language with a ranked differential. Free the first time, ready in 24 to 48 hours. The changing spot, the partner who noticed it and the man himself were all invented.

More NURS 6512 papers and MSN samples

NURS 6512 Week 5 questions, answered

Why are diagnostic words kept out of the examination?

Because the examination is evidence and the differential is the argument drawn from it. When a lesion is labeled suspicious in the examination, the reasoning has been decided before it is shown, and graders read that as a skipped step. Keeping the description neutral lets the differential stand on findings a reader can check for themselves.

Does the write-up conclude that the lesion is melanoma?

No. It ranks five possibilities and names the step that would separate the top two, which is where this course ends: at the differential. The page describes a graded document built on a composite patient. Any real lesion needs examination by a clinician, and nothing here stands in for that, whatever your prompt's case resembles.

Can the write-up work from an image the prompt supplies?

Yes. Many versions of this week provide images rather than a case narrative, and the example then describes exactly what the image shows in the same morphologic terms. It never draws on photographs of real patients from anywhere else. Where an image leaves a feature uncertain, such as texture or surface, the example records it as not assessable rather than guessing.

Where can I find a free NURS 6512 Week 5 sample paper?

The changing pigmented lesion write-up is reproduced here with subjective and objective data, ABCDE assessment, the ranked differential and the plan.

What step separates the top diagnoses in NURS 6512 Week 5?

Dermoscopy followed by excisional biopsy, since only tissue can tell melanoma from a benign lesion with certainty.