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|Poll|March 21, 2011

Progressively Enlarging Mass on the Lower Back

Author(s)Ted Rosen, MD

A 29-year-old man, previously in excellent health, presented with a progressively enlarging mass on the lower back of one-year’s duration. What would be the best initial course of action at this point?

A 29-year-old man, previously in excellent health, presented with a progressively enlarging mass on the lower back of one-year’s duration. Additional complaints included: pain radiating from the area, fatigue, intermittent fever and night sweats, and unexpected weight loss of 30 pounds. Family history was positive for melanoma (paternal grandfather) but not for other neoplasia.

What would be the best initial course of action at this point?

A. Inform the patient that this is a fatal malignancy and discharge to hospice care
B. Perform a biopsy with appropriate immunohistochemistry stains
C. Arrange emergency orthovoltage radiation therapy
D. Order a PET scan

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