| Course | DNP 605 Advanced Health Assessment Across Lifespan |
|---|---|
| Module | Module 3 |
| Paper type | Advanced SOAP note with differential diagnoses |
| Length | About 627 words, 5 pages |
| Format | APA 7 student paper |
| School | Arizona State University |
| Program | DNP |
| Updated | October 2026 |
Free sample paper for DNP 605 Module 3
The Mole His Wife Noticed: An Advanced SOAP Note With Differential Diagnoses for a Changing Skin Lesion
Student Name
Edson College of Nursing and Health Innovation, Arizona State University
DNP 605: Advanced Health Assessment Across Lifespan
Instructor Name
Month Day, Year
The Mole His Wife Noticed: An Advanced SOAP Note With Differential Diagnoses for a Changing Skin Lesion
Subjective
Chief concern: "My wife says the mole on my back looks different."
HPI: R.D., 58-year-old man, reports that his wife noticed a dark spot on his upper back about three months ago that has become larger and darker. He cannot see it himself. It occasionally itches but has not bled. No other new or changing lesions he knows of.
PMH: Hypertension. No prior skin cancer. No immunosuppression.
Medications: Amlodipine 5 mg daily.
Allergies: None.
Family history: Father had a "skin cancer removed from his ear"; type unknown. No known family melanoma.
Social history: Landscaper for 30 years, works outdoors; rarely uses sunscreen; several blistering sunburns as a teenager. Never smoked.
ROS: General: no weight loss or fatigue. Skin: as above. Lymph: no lumps noticed. Neuro: no headaches.
Objective
Fair skin, Fitzpatrick type II, with extensive sun damage on the face, neck and forearms. On the left upper back, a 9 mm by 7 mm macule with irregular, notched borders, uneven brown, black and focal blue-gray color, and asymmetry in shape and color. It stands out from his other nevi, which are small, round and uniformly tan. Dermoscopy shows an atypical pigment network and irregular dots. About 20 other nevi on the trunk appear benign. Several rough, scaly papules on the forearms. No palpable cervical, axillary or inguinal lymph nodes.
Assessment
The ABCDE checklist for melanoma looks for an asymmetric shape, irregular edges, mixed colors, a size over 6 mm and change over time. This lesion meets all five. It is also an ugly duckling, a lesion that looks different from the patient's other moles, which raises suspicion even when other criteria are not met (Swetter et al., 2019).
Differential diagnoses, ranked:
1. Cutaneous melanoma, superficial spreading type. Most likely given all ABCDE features, evolution reported by a family member, outdoor occupation, blistering sunburns and fair skin.
2. Dysplastic (atypical) nevus. Can show irregular borders and color, but focal blue-gray color and recent growth favor melanoma.
3. Pigmented basal cell carcinoma. Common in sun-damaged skin, but typically pearly and translucent with arborizing vessels, which were not seen.
4. Seborrheic keratosis. Common at his age and can be dark, but usually has a stuck-on, waxy appearance with milia-like cysts, which were absent.
5. Lentigo. Flat and pigmented from sun exposure, but usually uniform in color with smooth borders.
Also noted: probable actinic keratoses on the forearms, which reflect chronic sun damage.
Plan
Diagnostic: Excisional biopsy of the back lesion with narrow margins, full-thickness, to allow accurate measurement of depth if melanoma is confirmed, consistent with management guidelines (Swetter et al., 2019). Photograph the lesion before excision.
Therapeutic: Further treatment depends on pathology, including wider excision and staging if melanoma is confirmed. Treat actinic keratoses separately.
Education: Sun protection, monthly skin self-examination with his wife's help, and prompt reporting of new or changing lesions.
Follow-up: Review pathology in one to two weeks; full skin examination at least yearly, more often if melanoma is confirmed.
Additional History Questions
Has the lesion bled, ulcerated or crusted? Has he had prior biopsies? Does anyone in the family have melanoma or many moles? Has he used tanning beds?
Systems to Review and Exam Components
Full-body skin examination, including scalp, soles, nails and genitals, as described in standard examination texts (Bickley et al., 2021); lymph node examination of all basins; and, if melanoma is confirmed, a review of systems for neurologic, respiratory and abdominal symptoms that could suggest spread.
Note on Screening
For adults without symptoms, the USPSTF judged the evidence too limited to recommend for or against routine clinician skin checks (US Preventive Services Task Force, 2023). R.D.'s case is different: a changing lesion requires evaluation.
References
Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bates' guide to physical examination and history taking (13th ed.). Wolters Kluwer.
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
US Preventive Services Task Force. (2023). Screening for skin cancer: US Preventive Services Task Force recommendation statement. JAMA, 329(15), 1290-1295. https://doi.org/10.1001/jama.2023.4342
DNP 605 Module 3 instructions, in plain terms
The posted syllabus places the Advanced SOAP Note with Differential Diagnoses in Week 6, with group work beginning at Immersion 2, where groups receive a case of abnormal skin findings. Groups analyze the case, develop differential diagnoses using diagnostic reasoning, organize the information in SOAP format, identify potential causes and propose additional history questions, relevant systems to review and physical exam components. Together with the other two written assignments, it makes up 10% of the grade. Expect your group's case to differ from this one. Canvas has the submission details and rubric. Bring your group's draft differential list to the immersion so faculty can give feedback before the note is finalized and submitted.
How the DNP 605 Module 3 example is put together
The note follows SOAP format with subjective and objective sections kept separate. The objective section describes the lesion precisely, with size, borders, colors and dermoscopy, and compares it with the patient's other nevi. The assessment applies named criteria and ranks five differentials, each with reasons for and against. The plan addresses diagnostic, therapeutic, education and follow-up steps. Separate sections propose additional history questions and exam components, which the syllabus requires, and a brief note distinguishes screening from evaluation of a symptom. Each differential states its supporting and opposing findings in a sentence or two, which keeps the reasoning visible without padding. A screening note adds context. The plan covers diagnosis, treatment, teaching and follow-up in that order.
Where the marks sit in the DNP 605 Module 3 rubric
SOAP notes with differentials are commonly graded on organization, separation of subjective and objective data, precise description of findings, a ranked differential list with reasoning for each, an appropriate plan, and the additional questions and exam components the assignment asks for. Faculty look for differentials that are supported and refuted with specific findings rather than listed. Using accepted criteria, such as the ABCDEs, shows diagnostic reasoning. Group work should read as a single, consistent note. Notes that describe lesions with standard dermatologic terms, such as macule, papule and plaque, show precision faculty expect in advanced assessment. A biopsy plan with a rationale strengthens the plan section. Ranking differentials by likelihood shows clinical judgment.
DNP 605 Module 3 help: mistakes that cost marks
The most common weakness is a differential list without reasons. For each diagnosis, state what supports and what argues against it. Another is vague lesion description; give size, shape, borders, colors and texture. Keep subjective and objective data separate. Include the additional questions and exam components the syllabus asks for. Divide tasks within the group and have one member edit. If your group would like help with a SOAP note, send the materials to the desk. Use the standard dermatologic vocabulary for every lesion you describe, and include size in millimeters rather than comparisons to coins or fruit. Agree on a single voice for the group note.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 605 Module 3 questions, answered
Where can I find a free DNP 605 Module 3 sample paper?
The advanced SOAP note is above in full: a changing back mole in a 58-year-old landscaper, ranked differentials using the ABCDEs and the ugly duckling sign, a biopsy plan, additional questions and exam components.
What are the ABCDEs of melanoma?
Five warning features: an uneven shape, a ragged edge, more than one color, a width beyond 6 mm and evolution in size, shape or color.
What is the ugly duckling sign?
A lesion that looks different from a person's other moles, which raises suspicion for melanoma.
How should differential diagnoses be written in a SOAP note?
List them from most to least likely, with the findings for and against each one.
Is the DNP 605 SOAP note a group assignment?
Yes. The syllabus describes groups analyzing a case of abnormal skin findings, beginning at Immersion 2.