Basal Cell Carcinoma — MCQs
Which of the following is NOT a feature of Peutz-Jeghers syndrome?
A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
Somatic mutation of PTEN is seen in:
A skin biopsy shows 'tadpole' appearance of melanocytes. Which histological pattern would confirm Spitz nevus?
For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
Rodent ulcer is
A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?
A 70-year-old male presents with a red, scaling plaque on the lower lip that has not healed over the past few months. What is the most likely diagnosis?
Which of the following statements about Bowen's disease is correct?
Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
Basal Cell Carcinoma Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is NOT a feature of Peutz-Jeghers syndrome?
- A. Mucocutaneous pigmentation
- B. Autosomal recessive inheritance (Correct Answer)
- C. Autosomal dominant
- D. Hamartomatous polyp
Explanation: ***High risk of malignancy*** - Peutz-Jeghers syndrome is primarily associated with **benign hamartomatous polyps**, not a **high risk of malignancy**, which distinguishes it from other syndromes. - Although patients may develop cancers [1], the syndrome itself does not inherently denote a high malignancy risk like other syndromes such as familial adenomatous polyposis. *Autosomal dominant* - This syndrome is indeed **autosomal dominant**, caused by mutations in the STK11 gene. - Families with this condition typically show **vertical transmission**, characteristic of autosomal dominant inheritance. *Hamartomatous polyp* - Individuals with Peutz-Jeghers syndrome develop **hamartomatous polyps**, which are a hallmark feature of the condition [1]. - These polyps can occur in the gastrointestinal tract and are benign lesions rather than adenomatous type seen in other syndromes [1]. *Mucocutaneous pigmentation* - Mucocutaneous pigmentation, such as **freckling around the lips and buccal mucosa**, is a key clinical feature of Peutz-Jeghers syndrome. - This pigmentation usually appears in childhood and is often a distinguishing sign of the syndrome.
Question 2: A patient consults a dermatologist about a skin lesion on her neck. Examination reveals a 1-cm diameter, red, scaly plaque with a rough texture and irregular margins. Biopsy demonstrates epidermal cells with large, pleomorphic, hyperchromatic nuclei. What is the most likely diagnosis?
- A. Dermal nevus
- B. Actinic keratosis (Correct Answer)
- C. Junctional nevus
- D. Compound nevus
Explanation: ***Actinic keratosis*** - This diagnosis aligns with the description of a **red, scaly plaque** with a **rough texture** and **irregular margins**, which are classic clinical features of actinic keratosis. - The biopsy findings of epidermal and dermal cells with **large, pleomorphic, hyperchromatic nuclei** are consistent with **atypical keratinocytes**, a hallmark of actinic keratosis, indicating **premalignant change**. *Dermal nevus* - A dermal nevus is a **benign melanocytic lesion** that typically presents as a smooth, flesh-colored to light brown papule or nodule, not a scaly or rough plaque. - Histologically, it would show nests of nevus cells primarily in the **dermis** without the significant cellular atypia described. *Junctional nevus* - A junctional nevus is a **benign melanocytic lesion** characterized by nests of nevus cells located at the **dermoepidermal junction**. - Clinically, it appears as a flat or slightly raised, well-demarcated macule or papule, usually uniform in color, lacking the scaly, rough, and irregular features of the presented lesion. *Compound nevus* - A compound nevus is a **benign melanocytic lesion** with nevus cell nests present at both the **dermoepidermal junction** and within the dermis. - It typically presents as a raised, pigmented papule or nodule with a smooth or slightly warty surface, not a scaly plaque with irregular margins.
Question 3: Somatic mutation of PTEN is seen in:
- A. Endometrial carcinoma (Correct Answer)
- B. Osteosarcoma
- C. Carcinoma breast
- D. Retinoblastoma
Explanation: ***Endometrial carcinoma*** - Somatic mutations of the **PTEN gene** are frequently associated with endometrial carcinoma, particularly in **type I endometrial cancers** [1]. - These mutations lead to **dysregulation of cellular pathways**, contributing to the development and progression of the tumor [1]. *Carcinoma breast* - While breast cancer can exhibit various mutations, including in genes like **BRCA1/2**, PTEN mutations are **not commonly associated**. - Breast cancers typically have a different **molecular profile**, including hormone receptor status that is not linked to PTEN. *Osteosarcoma* - Osteosarcoma's genetic alterations mainly involve **RB gene** and **TP53 mutations**, rather than changes in the PTEN gene. - The typical pathology does not involve the **loss of PTEN function**, making it an unlikely association with this mutation. *Retinoblastoma* - Retinoblastoma is primarily associated with mutations in the **RB1 gene**, not PTEN, and is linked to **hereditary patterns**. - PTEN mutations do not play a significant role in the pathogenesis of retinoblastoma, differentiating its genetic basis from that of endometrial carcinoma. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, pp. 1015-1018.
Question 4: A skin biopsy shows 'tadpole' appearance of melanocytes. Which histological pattern would confirm Spitz nevus?
- A. Kamino bodies (Correct Answer)
- B. Civatte bodies
- C. Asteroid bodies
- D. Russell bodies
Explanation: ***Kamino bodies*** - Kamino bodies are **eosinophilic globules** found within the epidermis of a Spitz nevus, particularly at the **dermo-epidermal junction**. - Their presence, along with the characteristic **'tadpole' appearance of melanocytes** (spindled and epithelioid cells in nests), strongly supports the diagnosis of Spitz nevus. *Civatte bodies* - **Civatte bodies** (also known as apoptotic keratinocytes) are typically seen in conditions involving **lichenoid inflammation**, such as **lichen planus** or **lupus erythematosus**. - They represent **apoptotic keratinocytes** that have undergone necrosis, not a specific feature of Spitz nevus. *Asteroid bodies* - **Asteroid bodies** are star-shaped inclusions found within **giant cells** in granulomatous conditions, most notably **sarcoidosis**. - They are composed of lipids and proteins and are not associated with melanocytic lesions like Spitz nevus. *Russell bodies* - **Russell bodies** are **eosinophilic, hyaline inclusions** found within plasma cells, representing accumulations of **immunoglobulins** in conditions like **plasmacytomas**. - They are not a feature of Spitz nevus or other melanocytic proliferations.
Question 5: For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?
- A. Mohs surgery (Correct Answer)
- B. Superficial laser surgery
- C. Curettage and electrodesiccation
- D. Wide local excision
Explanation: ***Mohs surgery*** - **Mohs micrographic surgery** is the most popular and highly effective procedure specifically designed for **basal cell carcinoma (BCC)**, especially on the face and other cosmetically sensitive areas. - It involves the **progressive removal** of thin layers of skin, which are immediately examined under a microscope, allowing for complete tumor removal while preserving maximum healthy tissue. - Mohs surgery has the **highest cure rate** (95-99%) for BCC and is particularly preferred for high-risk locations, recurrent tumors, and poorly defined borders. *Superficial laser surgery* - While lasers can sometimes be used for very superficial skin lesions, **superficial laser surgery** is generally not the primary treatment for established **BCC** due to the risk of incomplete removal and recurrence. - It lacks the **histological margin control** provided by Mohs surgery, which is crucial for ensuring complete eradication of BCC. *Curettage and electrodesiccation* - **Curettage and electrodesiccation** is an alternative surgical treatment for small, low-risk BCCs in non-critical areas. - However, it has **lower cure rates** (85-95%) compared to Mohs surgery and does not provide histological margin assessment. - It is less preferred for facial BCCs where cosmetic outcome and complete removal are critical. *Wide local excision* - **Wide local excision** is a standard surgical approach that removes the tumor with predetermined margins (typically 4-5 mm for BCC). - While effective, it requires **larger tissue removal** compared to Mohs surgery and lacks the real-time microscopic margin control. - Mohs surgery remains more popular due to its tissue-sparing nature and higher cure rates, especially in cosmetically sensitive areas.
Question 6: Rodent ulcer is
- A. Squamous cell carcinoma
- B. Basal cell carcinoma (Correct Answer)
- C. Rhinophyma
- D. Adenocarcinoma (glandular cancer)
Explanation: ***Basal cell carcinoma*** - The term **"rodent ulcer"** is a historical and descriptive term for a specific type of **basal cell carcinoma (BCC)**, characterized by a **pearly raised border** and a central ulceration. - This appearance, with its rolled edges and sometimes visible telangiectasias, gives the impression of a lesion gnawing away at the tissue, hence the "rodent" description. *Squamous cell carcinoma* - While also a common skin cancer, **squamous cell carcinoma (SCC)** typically presents as a **scaly, crusted nodule or plaque** with irregular borders, or a non-healing ulcer that does not have the classic rolled border of a rodent ulcer. - It is more prone to **metastasis** than BCC. *Rhinophyma* - **Rhinophyma** is a severe form of **rosacea** that causes a bulbous, red, and swollen nose due to hyperplasia of sebaceous glands and connective tissue. - It is a **benign condition** and not a form of skin cancer or ulcer. *Adenocarcinoma (glandular cancer)* - **Adenocarcinoma** is a type of cancer that originates in **glandular tissue**, such as in the breast, prostate, colon, or lung. - It is **not a primary skin cancer** and does not typically present as a "rodent ulcer" on the skin surface.
Question 7: A male patient presented with a 0.3 cm nodule on the left nasolabial fold. A pathological examination revealed a basaloid appearance with peripheral palisading. What is the most likely diagnosis?
- A. Basal cell carcinoma (Correct Answer)
- B. Melanoma
- C. Squamous cell carcinoma
- D. Nevus
Explanation: ***Basal cell carcinoma*** - The description of a **basaloid appearance with peripheral palisading** on pathological examination is a classic histological feature of basal cell carcinoma (BCC). - BCC commonly presents as a nodule on sun-exposed areas like the **nasolabial fold** and is the most common skin cancer. *Melanoma* - Melanoma is characterized by the **malignant proliferation of melanocytes** and histologically shows atypical melanocytes with pagetoid spread or nest formation. - While it can appear as a nodule, the described **basaloid appearance with peripheral palisading** is not characteristic of melanoma. *Squamous cell carcinoma* - Squamous cell carcinoma typically shows **atypical keratinocytes** with keratinization, intercellular bridges, and sometimes desmoplasia. - It usually presents as an **erythematous, scaly patch** or nodule, often with ulceration, and the described histology does not match. *Nevus* - A nevus (mole) is a benign proliferation of melanocytes, showing **uniform nests of melanocytes** with maturation as they descend into the dermis. - The term **basaloid appearance** refers to cells resembling basal keratinocytes, which is not typical for a nevus.
Question 8: A 70-year-old male presents with a red, scaling plaque on the lower lip that has not healed over the past few months. What is the most likely diagnosis?
- A. Squamous cell carcinoma (Correct Answer)
- B. Basal cell carcinoma
- C. Actinic keratosis
- D. Lichen planus
Explanation: ***Squamous cell carcinoma*** - Presents as a **red, scaling plaque** on the lower lip, which is the **most common site for oral SCC** (90-95% of lip cancers) due to **chronic UV exposure**. - The history of **non-healing over several months** is highly suspicious for malignancy, particularly SCC in this location. - Lower lip SCC is common in elderly males with chronic sun exposure history. *Basal cell carcinoma* - Typically presents as a **pearly nodule with telangiectasias** or an ulcer, commonly found on sun-exposed skin but **rarely involves the lip**. - While BCC is the most common skin cancer overall, it is uncommon on the lips compared to SCC. *Actinic keratosis* - Characterized by **rough, scaling patches** on sun-exposed areas and is a **premalignant lesion** that can progress to SCC. - However, the description of a **non-healing lesion over months** points more strongly towards an already established malignancy (SCC) rather than a premalignant lesion. *Lichen planus* - An **inflammatory condition** that can affect the skin and mucous membranes, including the lips. - Oral lichen planus presents as **white lace-like patterns (Wickham's striae)** or erosions, not typically a persistent, red, scaling plaque that fails to heal.
Question 9: Which of the following statements about Bowen's disease is correct?
- A. Chronic sun exposure is a known risk factor.
- B. It is more common in fair-skinned individuals.
- C. There is a link between HSV infection and Bowen's disease.
- D. It is a form of squamous cell carcinoma in situ. (Correct Answer)
Explanation: ***It is a form of squamous cell carcinoma in situ.*** - **Bowen's disease** is, by definition, **squamous cell carcinoma in situ (SCC in situ)**. - It is characterized by full-thickness epidermal atypia of keratinocytes **without invasion through the basement membrane**. - This statement is **definitional** and represents the fundamental nature of what Bowen's disease is, making it the **best answer** among the options. *Chronic sun exposure is a known risk factor.* - This statement is **medically accurate**. Chronic UV exposure is indeed a well-established risk factor for Bowen's disease. - However, this describes a **risk factor** rather than defining what the condition is. - Other risk factors include **arsenic exposure**, **ionizing radiation**, **immunosuppression**, and **HPV infection** (particularly in anogenital sites). - While true, this is not as fundamental as the definitional statement. *It is more common in fair-skinned individuals.* - This statement is also **medically accurate**. Bowen's disease occurs more frequently in fair-skinned individuals (Fitzpatrick skin types I-II). - Fair skin provides less melanin protection against UV damage, increasing susceptibility to various forms of skin cancer including Bowen's disease. - However, this describes **epidemiology** rather than defining the condition itself. *There is a link between HSV infection and Bowen's disease.* - This statement is **incorrect**. There is **no established association** between Herpes Simplex Virus (HSV) and Bowen's disease. - **Human Papillomavirus (HPV)**, particularly high-risk types 16 and 18, is associated with Bowen's disease, especially in anogenital locations. - This represents a common confusion between HSV and HPV.
Question 10: Following the immunotherapy, in patients undergoing renal transplantation, the skin cancer most commonly seen is
- A. Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma) (Correct Answer)
- B. Hepatomas
- C. Kaposi's sarcoma
- D. Mycosis fungoides
Explanation: ***Non-melanoma skin cancers (Squamous cell carcinoma and Basal cell carcinoma)*** - **Immunosuppression** following renal transplantation significantly increases the risk of skin cancers, with non-melanoma types like **squamous cell carcinoma (SCC)** and **basal cell carcinoma (BCC)** being the most common [1]. - This increased risk is due to the impaired immune surveillance against oncogenic viruses (e.g., HPV) and DNA damage from UV radiation [2]. *Hepatomas* - While patients with chronic liver disease are at risk for hepatocellular carcinoma (hepatomas), they are **not the most common cancer** specifically associated with immunosuppression after renal transplantation. - The primary risk factors for hepatomas are chronic **hepatitis B** or **C infection**, alcohol abuse, and **cirrhosis**, not directly the immunosuppressive regimen itself. *Kaposi's sarcoma* - **Kaposi's sarcoma (KS)** is associated with **human herpesvirus 8 (HHV-8)** infection and is more prevalent in immunosuppressed individuals, especially those with AIDS or solid organ transplant recipients [2]. - Although its incidence is increased, it is still **less common** than non-melanoma skin cancers in this patient population. *Mycosis fungoides* - **Mycosis fungoides** is a type of **cutaneous T-cell lymphoma**, characterized by malignant T-lymphocytes infiltrating the skin. - It is a **rare cancer** and is not typically considered the most common skin cancer to occur in transplant recipients undergoing immunotherapy.
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