Recognizing Recurrence of Melanoma in an Emergency Department Patient: A Case Study.

Malignant melanoma incidence is rising faster than any other malignancy. Recurrent disease can occur in as many as 10% of patients diagnosed with primary malignant melanoma. In-transit melanoma is a type of locoregional disease that materializes when the cancer recurs as dermal and subdermal nodules found between the primary site and the lymph node drainage basin. Patients may not recognize the lesions as in-transit melanoma, and they may present to the emergency department for another matter completely. Ultimately, once recurrence is suspected, there must be a swift referral to oncology. Lack of recognition of this unique skin lesion could prove to be fatal. As frontline providers of care, emergency nurse practitioners should be alert to the characteristics of these lesions and the history that supports this dermatological condition.

The vaping epidemic: Calling nurses to action.

Youth e-cigarette use was declared a national epidemic in 2018. This article discusses e-cigarette- or vaping-associated lung injury (EVALI) and highlights the unique role nurses can have as advocates, patient educators, and champions of health promotion and disease prevention for their patients and families.

Smoke screen: The teen vaping epidemic uncovers a new concerning addiction.

The use of nicotine products among adolescents is now designated as a national epidemic by the United States Surgeon General. The largest one-year increase ever recorded for substance use in the adolescent population should sound the alarm for Nurse Practitioners (NPs) practicing in family health and pediatrics. Vaping, or the use of e-cigarettes or electronic nicotine delivery systems (ENDS), has been purported by the vaping industry as a less harmful alternative for tobacco users in their attempt to quit smoking. In adolescents, vaping represents a dangerous and highly addictive health behavior. Initiatives on both the state and federal levels have begun to address marketing and access to young users. However, the active involvement of NPs on the front line of primary care will be necessary to combat this imposing threat. The protection of our young patients from nicotine addiction and the education of patients and families about the potential dangers of e-cigarettes are imperative to prevent harm. This article addresses concerns related to e-cigarette use in the adolescent population and the important role NPs can play in promoting their health and well-being.

Recognizing Fournier's Gangrene in the Emergency Department.

Fournier's gangrene is a rare disease with a significant mortality rate. The potentially fatal disease stems from both aerobic and anaerobic bacteria and primarily occurs in men. The majority of Fournier's gangrene cases are idiopathic or derived from perineal and genital skin infections. Comorbid risk factors include diabetes mellitus, alcohol misuse, and immunosuppression (). The infection initially presents as a cellulitis in the perineum or perianal area. As Fournier's gangrene progresses, the infected tissue becomes swollen, significantly painful, and necrotic. The progression of infection can lead to systemic symptoms, sepsis, and death. Early intervention is a key component in the treatment plan for Fournier's gangrene. The primary intervention is surgical debridement of the necrotic tissue. If an abscess is present, incision and drainage are indicated. In addition to surgical debridement, the administration of broad-spectrum antibiotics and hemodynamic stabilization are required (). Complications after treatment include chronic pain, sexual dysfunction, decreased sensation of the penile skin, and scarring ().