Practice questions, skin tumors 3
Practice
questions, skin tumors 3
© Jun Wang, MD, PhD
1. Use this case
and this image for the next two questions. A 21-year-old woman presents
with irregular discoloration of her right hands for 3 months. She denies any
abnormal sensation. Her past medical history is unremarkable. She is a full
time college student in literature, and is not working. She denies history of
injury or infection. Physical examination is unremarkable except the right hand
changes as shown. The skin surface of this lesion is smooth. What is the
diagnosis?
(Image: Produnis [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0/)])
A. Actinic keratosis
B. Acute contact dermatitis
C. Dermatophytosis
D. Scar
E. Vitiligo
2. A 21-year-old woman presents with irregular
discoloration of her right hands for 3 months. She denies any abnormal
sensation. Her past medical history is unremarkable. She is a full time college
student in literature, and is not working. She denies history of injury or
infection. Physical examination is unremarkable except the right hand changes
as shown. The skin surface of this lesion is smooth. What is associated with
these changes?
(Image: Produnis [CC BY-SA 3.0
(http://creativecommons.org/licenses/by-sa/3.0/)])
A. Allergic reaction
B. Excess estrogen
C. Melanocytic destruction
D. Sun exposure
E. Tyrosinase mutation
3. Use this case
and this image for the next two questions. A 29-year-old woman presents
with irregular discoloration of her face for 2 months. She does not have
abnormal sensation. She is pregnant in her second trimester. Her prenatal
process and past medical history is unremarkable. She has a 5 pack-year history
of smoking but quitted after she was pregnant. She does not drink alcohol or
use illicit drugs. Physical examination is unremarkable except the lesion
shown. What is likely associated with her skin changes?
(Image: User:Elord from Wikidocs [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. BRAF mutation
B. Cigarette smoking
C. Excess estrogen
D. Melanocytic proliferation
E. Tyrosinase mutation
4. A 29-year-old woman presents with irregular
discoloration of her face for 2 months. She does not have abnormal sensation.
She is pregnant in her second trimester. Her prenatal process and past medical
history is unremarkable. She has a 5 pack-year history of smoking but quitted
after she was pregnant. She does not drink alcohol or use illicit drugs.
Physical examination is unremarkable except the lesion shown. What is the
diagnosis?
(Image: User:Elord from Wikidocs [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. Actinic keratosis
B. Bowen disease
C. Junctional nevus
D. Melanoma
E. Melasma
5. Use this
image for the question. A 44-year-old man presents with irregular
discoloration of his left face for 2 months. He does not have abnormal
sensation. He has type 1 diabetes. He has a 20 pack year history of cigarette
smoking and drinks two cans of beer every day. His family history is
significant for multiple skin squamous cell carcinoma, basal cell carcinoma and
melanoma. Physical examination reveals a 0.7 cm irregular light brown macule at
his left cheek. An image of the biopsy is shown. Immunohistochemistry studies
reveals S-100 positive cells in basal layer only. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Actinic keratosis
B. Dysplastic nevus
C. Junctional nevus
D. Lentigo
E. Lentigo maligna
6. Use this
image for the question. A 44-year-old man presents with irregular
discoloration of his left face for 2 months. He does not have abnormal
sensation. He has type 1 diabetes. He has a 20 pack year history of cigarette
smoking and drinks two cans of beer every day. His family history is
significant for multiple skin squamous cell carcinoma, basal cell carcinoma and
melanoma. Physical examination reveals a 0.6 cm irregularly pigmented brown
macule at his left cheek. An image of the biopsy is shown. Immunohistochemistry
studies reveals S-100 positive cells in basal layer and upper epidermis, but
not in dermis. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Actinic keratosis
B. Dysplastic nevus
C. Junctional nevus
D. Lentigo
E. Lentigo maligna
F. Lentigo maligna melanoma
7. Use this case
and this image for the next two questions. A 51-year-old woman presents
with irregular discoloration of her left forearm for 2 months. She does not
have abnormal sensation. She has type 2 diabetes. She has a 35 pack year
history of cigarette smoking and drinks two glasses of wine daily. Her family
history is significant for multiple skin squamous cell carcinoma, basal cell
carcinoma and melanoma. Physical examination reveals a 1.2 cm irregularly
pigmented brown macule with smooth surface at her left forearm. An image of the
biopsy is shown. Immunohistochemistry studies reveals S-100 positive cells in
basal layer, upper epidermis, and in dermis. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Junctional nevus
B. Lentigo
C. Lentigo maligna
D. Lentigo maligna melanoma
E. Paget disease
8. A 51-year-old woman presents with irregular
discoloration of her left forearm for 2 months. She does not have abnormal
sensation. She has type 2 diabetes. She has a 35 pack year history of cigarette
smoking and drinks two glasses of wine daily. Her family history is significant
for multiple skin squamous cell carcinoma, basal cell carcinoma and melanoma.
Physical examination reveals a 1.2 cm irregularly pigmented brown macule with
smooth surface at her left forearm. An image of the biopsy is shown.
Immunohistochemistry studies reveals S-100 positive cells in basal layer, upper
epidermis, and in dermis. What is the most important risk factor for these
changes?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Adenocarcinoma in nearby tissue
B. Alcohol usage
C. Cigarette smoking
D. Human papilloma virus
E. Sun exposure
9. Use this
image for the question. A 44-year-old man presents with irregular
discoloration of his left hand for 2 months. He does not have abnormal
sensation. His past medical history and family history are unremarkable.
Physical examination reveals a 0.4 cm evenly pigmented dark brown macule at his
left dorsal hand. An image of the biopsy is shown. Immunohistochemistry studies
reveals S-100 positive cells in basal layer, but not in upper epidermis nor
dermis. What is the diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Dysplastic nevus
B. Intradermal nevus
C. Junctional nevus
D. Lentigo
E. Lentigo maligna
10. Use this
image for the question. A 44-year-old man presents with painless growth of
his left chest for many years. His past medical history and family history are
unremarkable. Physical examination reveals a 0.8 cm light brown rubbery
polypoid growth at his left chest. An image of the biopsy is shown.
Immunohistochemistry studies reveals S-100 positive cells in basal layer, but
not in upper epidermis. The clusters of cells in dermis is positive for S-100.
What is the diagnosis?
(KGH assumed (based on copyright claims). [CC BY-SA
3.0 (http://creativecommons.org/licenses/by-sa/3.0/)])
A. Dysplastic nevus
B. Intradermal nevus
C. Junctional nevus
D. Melanoma
E. Neurofibroma
11. Use this case
and this image for the next two questions. A 52-year-old woman presents
with irregular painless nodule of her left leg for many years. Her past medical
history and family history are unremarkable. Physical examination reveals a 0.8
cm light brown rubbery polypoid growth at his left chest. An image of the
biopsy is shown. Immunohistochemistry studies reveals S-100 positive cells in
basal layer, but not in upper epidermis. The clusters of cells in dermis are
positive for S-100. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Compound nevus
B. Dysplastic nevus
C. Intradermal nevus
D. Junctional nevus
E. Melanoma
12. A 52-year-old woman presents with irregular
painless nodule of her left leg for many years. Her past medical history and
family history are unremarkable. Physical examination reveals a 0.8 cm light
brown rubbery polypoid growth at his left chest. An image of the biopsy is
shown. Immunohistochemistry studies reveals S-100 positive cells in basal layer,
but not in upper epidermis. The clusters of cells in dermis are positive for
S-100. Abnormality of what gene is likely associated with these findings?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. BRAF
B. CYLD
C. MSH2
D. PDGFB
E. PTCH
13. Use this case
and this image for the next two questions. A 52-year-old woman presents
with irregular painless nodule of her left leg for many years. Her past medical
history and family history are unremarkable. Physical examination reveals a 0.8
cm light brown rubbery raised growth at her left leg. The surface of the
lesion is smooth. No ulceration is noted. An image of the biopsy is shown.
Immunohistochemistry studies reveals S-100 positive cells in basal layer, but
not in upper epidermis. The clusters of cells in dermis are positive for S-100.
What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Dysplastic nevus
B. Intradermal nevus
C. Junctional nevus
D. Malignant melanoma
E. Melanoma in situ
14. A 52-year-old woman presents with irregular
painless nodule of her left leg for many years. Her past medical history and
family history are unremarkable. Physical examination reveals a 0.8 cm light
brown rubbery raised growth at her left leg. The surface of the lesion is
smooth. No ulceration is noted. An image of the biopsy is shown.
Immunohistochemistry studies reveals S-100 positive cells in basal layer, but
not in upper epidermis. The clusters of cells in dermis are positive for S-100.
What risk she has due to this lesion?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Adult T cell lymphoma
B. Basal cell carcinoma
C. Malignant melanoma
D. Mycosis fungoides
E. Squamous cell carcinoma
15. Use this case
and this image for the next two questions. A 61-year-old woman presents pruritic
left nipple lesion for 3 weeks. She has type 2 diabetes and hypertension. She
has a history of left breast low-grade ductal carcinoma in situ 5 years ago that
was resected. Physical examination reveals scaly changes of the left nipple. No
other abnormality is noted. An image of the nipple biopsy is shown. What set of
tests is needed to confirm the diagnosis?
(Image: Nephron [CC BY-SA 3.0 (https://creativecommons.org/licenses/by-sa/3.0)])
A. CD3 and CD20
B. CD4 and CD8
C. CK7 and HMB45
D. Pancytokeratin and CD45
E. Silver stain for fungus
16. A 61-year-old woman presents pruritic left nipple
lesion for 3 weeks. She has type 2 diabetes and hypertension. She has a history
of left breast low-grade ductal carcinoma in situ 5 years ago that was
resected. Physical examination reveals scaly changes of the left nipple. No
other abnormality is noted. An image of the nipple biopsy is shown.
Immunohistochemistry studies are performed. These pale
cells are positive for HMB45 and negative for CK7. However, no HMB45 positive
cells are seen in the dermis. What is the diagnosis?
(Image: Nephron [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Invasive melanoma
B. Junctional nevus
C. Lentigo
D. Melanoma in situ
E. Paget disease
17. Use this case
and this image for the next three questions. A 48-year-old man presents
slowly growing left should painless mass for 3 months. He has a history of left
axillary Hodgkin lymphoma at age of 39 that was treated with chemotherapy and
radiation therapy. He has a 30 pack year history of cigarette smoking and
drinks 6 cans of beer daily. Physical examination reveals a 1.5 cm dark brown
plaque with irregular border and uneven pigmentation. The skin surface is
focally eroded. No other abnormality is noted. An image of the biopsy is shown.
Immunohistochemistry studies reveal HMB45 positive atypical cells scatters in
full epidermis and dermis. What is the
diagnosis?
(Image: J Wisell [Public domain])
A. Compound nevus
B. Invasive melanoma
C. Melanoma in situ
D. Recurrent Hodgkin lymphoma
E. Squamous cell carcinoma
18. A 48-year-old man presents slowly growing left
should painless mass for 3 months. He has a history of left axillary Hodgkin
lymphoma at age of 39 that was treated with chemotherapy and radiation therapy.
He has a 30 pack year history of cigarette smoking and drinks 6 cans of beer
daily. Physical examination reveals a 1.5 cm dark brown plaque with irregular
border and uneven pigmentation. The skin surface is focally eroded. No other
abnormality is noted. An image of the biopsy is shown. Immunohistochemistry
studies reveal HMB45 positive atypical cells scatters in full epidermis and
dermis. What is most likely associated
with these findings?
A. Alcohol usage
B. Cigarette smoking
C. EB virus
D. Human papilloma virus
E. Sun exposure
19. A 48-year-old man presents slowly growing left
should painless mass for 3 months. He has a history of left axillary Hodgkin
lymphoma at age of 39 that was treated with chemotherapy and radiation therapy.
He has a 30 pack year history of cigarette smoking and drinks 6 cans of beer
daily. Physical examination reveals a 1.5 cm dark brown plaque with irregular
border and uneven pigmentation. The skin surface is focally eroded. No other
abnormality is noted. An image of the biopsy is shown. Immunohistochemistry
studies reveal HMB45 positive atypical cells scatters in full epidermis and
dermis. What is the most important
indicator of his prognosis?
A. Age
B. Cigarette smoking
C. Distance between granular layer to the deepest pale
cells
D. Greatest dimension of the lesion on surface
E. History of chemotherapy and radiation therapy
20. Use this
image for the question. A 54-year-old man presents with an ulcerated lesion
at his back. He has history of multiple actinic keratosis and basal cell
carcinoma. He does not smoke cigarette or drink alcohol. Physical examination
reveals a 1.2 cm firm nodule with wide base and a 0.5 cm ulcer. The lesion is
resected and an image of the microscopic exam is shown. What is most likely the
diagnosis?
(Image: LWozniak&KWZielinski [CC BY-SA 3.0
(https://creativecommons.org/licenses/by-sa/3.0)])
A. Basal cell carcinoma
B. Invasive melanoma
C. Melanoma in situ
D. Merkel cell carcinoma
E. Squamous cell carcinoma
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