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Mr. Jones presented to his dermatologist, Dr. Adams, with a large atypical pigmented lesion on his back. Biopsy of the lesion revealed malignant melanoma. The lesion extended to 3.2mm at the depth of the specimen. Although the lesion was surgically removed, metastases to multiple organs soon became apparent. Although an oncologist followed Mr. Jones, he also continued to be observed by Dr. Adams. As is often the case with multiple organ metastases, Mr. Jones suffered from chronic pain. Dr. Adams, showing compassion for his patient, began to prescribe potent narcotic painkillers.