Skin biopsies are appropriate when the nature of the lesion…

Skin biopsies are appropriate when the nature of the lesion or dermatitis is in question.  It is becoming more common for primary care providers to perform skin biopsies.  Punch and shave biopsies are the most common.    Why would a punch biopsy be the biopsy of choice for a primary care provider evaluating a lesion for melanoma?

A 28-year-old female returns to the clinic to see you. You i…

A 28-year-old female returns to the clinic to see you. You initially treated her for moderate depression with fluoxetine (Prozac), an SSRI, 20 mg daily. You recommended a follow up  visit in 3-4 weeks. She missed that appointment, she was feeling less depressed and canceled her appointment.   Two months have gone by, she called your office this morning and asked to schedule an appointment with you.  She is feeling a bit “crazy and manic” on the fluoxetine.  She is rushing around, laughing a lot and experiencing more anxiety. She has a family history of severe mood swings, she passed it off as just that. Based on this information, what is the most likely, or leading diagnosis for this person: