Station - Instructions for candidate
You are a final-year medical student on a general practice placement in Kalgoorlie, running scheduled telehealth consultations from the practice consulting room.
Kevin Lim, a 52-year-old practice patient, is on the line for his scheduled result consultation about a lump taken from his back a fortnight ago. The laboratory report is attached to this sheet.
| Procedure note (14 days ago) | 12 mm irregular brown-black patch, right upper back below the scapula, removed as a narrow-margin excision biopsy under local anaesthetic in the practice minor operations room. Sutures in situ; wound reviewed by the practice nurse 4 days ago - clean and healing, no signs of infection. |
|---|---|
| Telehealth check | Kevin Lim, DOB 14 April 1974, identified by full name and date of birth against the practice record at the start of the call. Home address in Kalgoorlie and a working mobile number confirmed on file in case the call drops. Two-way audio and video are stable. |
| Call context | The practice nurse telephoned Kevin yesterday to say the result was back and to book today's video consultation. His wife Mei is sitting beside him and has been present throughout. |
Results provided:
Histopathology report - right upper back lesion
| Item | Value | Reference range |
|---|---|---|
| Specimen | Excision biopsy, 12 mm pigmented lesion, right upper back | - |
| Diagnosis | Invasive melanoma, superficial spreading type | - |
| Breslow thickness | 1.4 mm | - |
| Ulceration | Present | - |
| Mitotic rate | 2 mitoses/mm2 | - |
| Lymphovascular invasion | Not seen | - |
| Peripheral margin | Involved at one point; closest clearance 0.5 mm | - |
| Deep margin | Clear at 2 mm | - |
Comment: Tumour invades the dermis to a depth of 1.4 mm beneath an ulcerated epidermis. Given the positive peripheral margin, this excision should be regarded as diagnostic and incomplete. Case to be discussed at the metropolitan melanoma multidisciplinary meeting.
Your tasks are to:
- Take a focused history of the lesion that was removed and any relevant background.
- Explain the histopathology result to Kevin in plain language, checking his understanding as you go.
- Respond to Kevin's reaction to the news.
- Outline the initial management plan, including referrals and staging, and close the telehealth consultation safely.
- You do NOT need to summarise your findings to the examiner.
- You are not required to examine the patient in this station; this is a telehealth consultation.
- You do not need to write referrals, scripts or work certificates - describing the plan is sufficient.
This is a 15-minute station, with 2 minutes of reading time.