Skin Tumors Practice Questions

Q: A 40-year-old man presents with a single erythematous plaque on the penis. Histologic examination reveals dysplastic cells throughout the epidermis. Which of the following statements about the disease is FALSE?

Transformation to invasive carcinoma is common. **Diagnosis: Erythroplasia of Queyrat (Squamous Cell Carcinoma in situ of the Penis)** The clinical presentation of a solitary erythematous plaque on the glans penis or prepuce in an uncircumcised male, combined with histology showing full-thickness epidermal dysplasia, confirms a diagnosis of **Erythroplasia of Queyrat (EQ)**. **Explanation of the Correct Answer:** * **Option C is FALSE:** While Erythroplasia of Queyrat is a precursor to invasive squamous cell carcinoma (SCC), the rate of transformation is relatively low, occurring in approximately **10%** of cases. Therefore, saying transformation is "common" is clinically inaccurate. **Analysis of Incorrect Options:** * **Option A (True):** By definition, "in situ" carcinoma means the dysplastic cells are confined to the epidermis and have **not** breached the basement membrane. * **Option B (True):** This condition typically affects older, uncircumcised males. Chronic irritation, accumulation of smegma, and lack of hygiene are significant risk factors. * **Option D (True):** There is a strong oncogenic association with **High-Risk HPV (types 16 and 18)**, which integrate into the host genome and inactivate tumor suppressor genes (p53 and Rb). **High-Yield NEET-PG Pearls:** * **Bowen’s Disease vs. Erythroplasia of Queyrat:** Both are SCC in situ. Bowen’s disease occurs on keratinized skin (scaly plaque), while EQ occurs on mucosal/glans surfaces (velvety red plaque). * **Bowenoid Papulosis:** Presents as multiple pigmented papules; histologically similar to SCC in situ but clinically benign and rarely progresses to malignancy. * **Histology:** Look for "windblown appearance" (disordered maturation), pleomorphic nuclei, and frequent mitoses. * **Treatment of choice:** Mohs micrographic surgery or topical 5-Fluorouracil/Imiquimod.

Q: Acanthosis nigricans is most commonly associated with carcinoma of which organ?

Bronchus. **Explanation:** Acanthosis Nigricans (AN) is a dermatological marker characterized by hyperpigmented, velvety plaques in intertriginous areas. While most commonly associated with insulin resistance (Type 2 Diabetes, PCOS), **Malignant Acanthosis Nigricans** is a classic paraneoplastic syndrome. **Why Bronchus is the Correct Answer:** In the context of internal malignancies, Acanthosis Nigricans is most frequently associated with **adenocarcinomas of the gastrointestinal tract**, with the **Stomach** being the single most common site (approx. 55-60%). However, when evaluating the provided options, **Bronchus (Lung)** is the most frequent site among the choices listed. Malignant AN is often triggered by the secretion of Transforming Growth Factor-alpha (TGF-α) by the tumor, which stimulates epidermal keratinocytes and fibroblasts. **Analysis of Incorrect Options:** * **B. Breast:** While breast cancer can occasionally present with paraneoplastic skin changes, it is significantly less common than GI or respiratory tract malignancies in the context of AN. * **C. Colon:** Though a GI malignancy, colon cancer is less frequently associated with AN compared to gastric or bronchial carcinomas. * **D. Testis:** Testicular tumors are rarely associated with AN; they are more commonly linked to other paraneoplastic phenomena or hormonal changes. **High-Yield Clinical Pearls for NEET-PG:** * **Malignant AN vs. Benign AN:** Malignant AN usually has a sudden onset, rapid progression, involvement of atypical sites (palms/soles—"Tripe Palms"), and is more extensive. * **Tripe Palms:** If seen with AN, it strongly suggests **Gastric Carcinoma**. If seen alone, it suggests **Bronchogenic Carcinoma**. * **Leser-Trélat Sign:** The sudden eruption of multiple seborrheic keratoses, often seen alongside malignant AN, indicating internal malignancy (usually GI).

Q: Mycosis fungoides mainly affects which type of cell?

T cells. **Explanation:** **Mycosis Fungoides (MF)** is the most common form of **Cutaneous T-Cell Lymphoma (CTCL)**. It is a primary cutaneous malignancy characterized by the clonal proliferation of skin-homing **CD4+ T helper cells**. The disease typically follows a chronic, indolent course, progressing through three classic clinical stages: Patch, Plaque, and Tumor. * **Why T cells is correct:** The malignant cells in MF are mature, memory T lymphocytes (specifically **CD4+ phenotype**) that express cutaneous lymphocyte antigen (CLA). These cells infiltrate the epidermis, a phenomenon known as **epidermotropism**, often forming pathognomonic clusters called **Pautrier’s microabscesses**. * **Why other options are incorrect:** * **B-cells & Plasma cells:** While B-cell lymphomas can occur in the skin (e.g., Marginal zone lymphoma), MF is strictly a T-cell malignancy. Plasma cell dyscrasias (like Multiple Myeloma) involve the bone marrow and antibody production, not primary skin infiltration. * **Macrophages:** These are myeloid-derived phagocytic cells. While they may be present in the inflammatory infiltrate of various skin lesions, they are not the neoplastic component of MF. **High-Yield Clinical Pearls for NEET-PG:** 1. **Sezary Syndrome:** The leukemic (systemic) variant of MF characterized by the triad of erythroderma, lymphadenopathy, and circulating atypical T cells (**Sezary cells** with "cerebriform" nuclei). 2. **Histology:** Look for "haloed" lymphocytes and **Pautrier’s microabscesses** (intraepidermal collections of T cells). 3. **Clinical Sign:** "Bathing suit distribution" (lesions often appear in non-sun-exposed areas). 4. **Immunophenotype:** Usually **CD3+, CD4+, and CD8-**. Loss of normal T-cell markers like CD7 is a diagnostic clue.

Q: Malignant form of intraoral acanthosis nigricans is associated with which of the following?

Internal malignancy. **Explanation:** **Acanthosis Nigricans (AN)** is a dermatosis characterized by hyperpigmented, velvety plaques typically found in intertriginous areas. While most cases are benign (associated with insulin resistance and obesity), the **malignant form** is a classic paraneoplastic syndrome. **1. Why Option A is Correct:** Malignant Acanthosis Nigricans is strongly associated with **internal malignancies**, most commonly **adenocarcinomas of the gastrointestinal tract** (stomach cancer accounts for ~60% of cases). The sudden onset, rapid progression, and involvement of atypical sites like the **oral mucosa**, palms (tripe palms), or soles are hallmarks of malignancy. Intraoral involvement manifests as fine, verrucous, or papillomatous growths on the tongue and lips, which are rarely seen in the benign form. **2. Why Other Options are Incorrect:** * **Option B & C:** The term "external malignancy" refers to primary skin cancers (like BCC or SCC). While skin cancers exist, malignant AN is specifically triggered by systemic growth factors (like TGF-alpha) secreted by **visceral (internal)** tumors. It is not a reaction to primary external skin tumors. * **Option D:** Incorrect as the association with internal malignancy is a well-established medical fact. **Clinical Pearls for NEET-PG:** * **Most common site of malignancy:** Stomach (Adenocarcinoma). * **Tripe Palms:** Velvety thickening of palmar ridges; if present with AN, it highly suggests internal cancer (Lung or Stomach). * **Leser-Trélat Sign:** Sudden eruption of multiple seborrheic keratoses; often co-exists with malignant AN. * **Key Difference:** Unlike benign AN, the malignant form is usually not associated with obesity and appears in older individuals.

Q: Which of the following tumors is not caused by PUVA therapy?

Cutaneous T-cell lymphoma. **Explanation:** PUVA (Psoralen + Ultraviolet A) therapy is a potent photochemotherapy used for various dermatological conditions. However, it is well-documented to be **carcinogenic** due to its ability to cause direct DNA damage (photo-adducts) and localized immunosuppression. **Why Cutaneous T-cell Lymphoma (CTCL) is the correct answer:** CTCL (such as Mycosis Fungoides) is **not caused** by PUVA; rather, PUVA is a primary **treatment modality** for early-stage CTCL. PUVA works by inducing apoptosis in malignant T-cells within the skin. It does not have a causal relationship with the development of lymphoid malignancies. **Analysis of Incorrect Options:** * **Squamous Cell Carcinoma (SCC):** This is the **most common** skin cancer associated with long-term PUVA therapy. The risk is dose-dependent and significantly increases after 200–250 treatments. * **Basal Cell Carcinoma (BCC):** While less common than SCC in the context of PUVA, the risk of BCC is still significantly elevated in patients receiving high cumulative doses of UVA. * **Melanoma:** Long-term follow-up studies (notably the 1975 PUVA Follow-up Study) have shown an increased risk of malignant melanoma, particularly 15 or more years after the first exposure to PUVA. **High-Yield Clinical Pearls for NEET-PG:** * **SCC vs. BCC Ratio:** In the general population, BCC is more common than SCC. However, in patients treated with **PUVA or Arsenic**, this ratio is **reversed** (SCC becomes more common than BCC). * **PUVA Lentigines:** These are distinct, stellate-shaped hyperpigmented macules that appear in PUVA-treated areas and serve as a marker of high cumulative UV exposure. * **Action Spectrum:** PUVA primarily uses UVA (320–400 nm), whereas UVB (290–320 nm) is used in Narrowband-UVB therapy.

Q: All are true about squamous cell carcinoma of the skin except?

Hematogenous spread is common and occurs early.. ### Explanation **Correct Answer: C. Hematogenous spread is common and occurs early.** **Why Option C is the Correct Answer (The False Statement):** Squamous Cell Carcinoma (SCC) of the skin primarily spreads via **lymphatic channels** to regional lymph nodes. While metastasis can occur, it is generally late and relatively uncommon (occurring in about 2–5% of cases, though higher in high-risk sites). **Hematogenous (blood-borne) spread is rare** and typically occurs only in very advanced, neglected cases. This distinguishes it from other aggressive tumors where early blood-borne metastasis is a hallmark. **Analysis of Other Options:** * **Option A (True):** When SCC arises in a site of chronic inflammation, such as a burn scar, chronic osteomyelitis sinus, or vaccination scar, it is specifically termed a **Marjolin’s ulcer**. These are often more aggressive than UV-induced SCC. * **Option B (True):** Radiotherapy is a recognized treatment modality for SCC, especially in patients who are poor surgical candidates, for tumors in locations where surgery would be disfiguring, or as adjuvant therapy for high-risk lesions. * **Option D (True):** Chronic irritation is a major risk factor. SCC frequently develops in chronic ulcers (e.g., venous stasis ulcers) or areas of long-standing discoid lupus erythematosus (DLE). **High-Yield Clinical Pearls for NEET-PG:** * **Precursor Lesions:** Actinic keratosis (most common) and Bowen’s disease (SCC in-situ). * **Risk Factors:** UV radiation (most common), arsenic exposure, immunosuppression, and HPV (types 16, 18). * **Histopathology:** Characterized by **keratin pearls** and intercellular bridges (desmosomes). * **Keratoacanthoma:** A rapidly growing variant of SCC that may undergo spontaneous regression. * **Marjolin’s Ulcer:** Characteristically lacks a sensory nerve supply (painless) and has a higher metastatic potential than standard SCC.

Q: Multiple odontogenic keratocysts are associated with which of the following conditions?

Gorlin-Goltz syndrome. **Explanation:** **Gorlin-Goltz Syndrome (Nevoid Basal Cell Carcinoma Syndrome)** is an autosomal dominant disorder caused by a mutation in the **PTCH1 gene** on chromosome 9q. The presence of **multiple Odontogenic Keratocysts (OKCs)** of the jaw is a major diagnostic criterion, often appearing in the first two decades of life. These cysts are frequently the first clinical sign of the syndrome. **Why other options are incorrect:** * **Gardner’s Syndrome:** A variant of Familial Adenomatous Polyposis (FAP) characterized by intestinal polyps, **osteomas** (especially of the mandible), and soft tissue tumors (desmoids/epidermoid cysts). It does not typically feature OKCs. * **Goldenhar’s Syndrome (Oculo-Auriculo-Vertebral Dysplasia):** A developmental anomaly involving the first and second branchial arches. Key features include hemifacial microsomia, epibulbar dermoids, and preauricular tags. * **Grinspan Syndrome:** A clinical triad consisting of **Lichen Planus, Diabetes Mellitus, and Hypertension**. It is not associated with jaw cysts. **High-Yield Clinical Pearls for NEET-PG:** * **Gorlin-Goltz Triad:** Multiple Basal Cell Carcinomas (BCCs), Multiple OKCs, and skeletal anomalies (e.g., **bifid ribs**, ectopic calcification of the falx cerebri). * **Dermatological hallmark:** Palmar and plantar pits (shallow depressions in the stratum corneum). * **Radiology:** "Lacy" or lamellar calcification of the falx cerebri is a classic sign. * **Inheritance:** Autosomal Dominant; PTCH1 gene is a tumor suppressor gene in the Hedgehog signaling pathway.

Q: Which of the following is NOT a premalignant skin lesion?

Miliaria. **Explanation:** The correct answer is **D. Miliaria**. **Miliaria** (commonly known as prickly heat) is a benign, transient inflammatory condition caused by the obstruction of sweat ducts and the subsequent leakage of sweat into different layers of the skin. It is categorized into *crystallina, rubra, and profunda* based on the level of obstruction. It has **no malignant potential** and is not associated with cellular dysplasia. **Analysis of Premalignant Options:** * **Bowen’s Disease:** This is defined as **Squamous Cell Carcinoma (SCC) in situ**. It involves full-thickness dysplasia of the epidermis without invasion through the basement membrane. If left untreated, it can progress to invasive SCC. * **Actinic Keratoses (Solar Keratoses):** These are the most common premalignant skin lesions. They occur on sun-damaged skin and represent early, intraepidermal proliferation of atypical keratinocytes. They are considered precursors to SCC. * **Discoid Lupus Erythematosus (DLE):** While primarily an autoimmune connective tissue disorder, chronic DLE lesions (especially on the scalp or lips) involve persistent inflammation and scarring. Long-standing DLE carries a risk of developing **Squamous Cell Carcinoma** within the chronic scars. **High-Yield Clinical Pearls for NEET-PG:** * **Other Premalignant Lesions:** Leukoplakia, Erythroplasia of Queyrat, Xeroderma Pigmentosum, and Arsenic Keratosis. * **Marjolin’s Ulcer:** This refers to an aggressive SCC arising in areas of chronic scarring, such as old burn scars or chronic DLE lesions. * **Actinic Cheilitis:** A variant of actinic keratosis occurring on the lips (usually the lower lip).

Question 1

Hyperkeratosis of the palms and soles is seen in which of the following conditions?

Accepted Answer

Carcinoma of the esophagus

Answer

Carcinoma of the colon

Answer

Hepatoma

Answer

Adenocarcinoma of the lung

Question 2

A 40-year-old man presents with a single erythematous plaque on the penis. Histologic examination reveals dysplastic cells throughout the epidermis. Which of the following statements about the disease is FALSE?

Accepted Answer

Transformation to invasive carcinoma is common

Answer

Intact basement membrane

Answer

Occurs in older uncircumcised males

Answer

Strong association with HPV types 16 and 18

Question 3

Acanthosis nigricans is most commonly associated with carcinoma of which organ?

Accepted Answer

Bronchus

Answer

Breast

Answer

Colon

Answer

Testis

Question 4

Which of the following is a clinical feature often associated with a tumour?

Accepted Answer

Hypertrophic osteoarthropathy

Answer

Grotton's papules

Answer

Acanthosis nigricans

Answer

Dermatomyositis

Question 5

Mycosis fungoides mainly affects which type of cell?

Accepted Answer

T cells

Answer

B-cells

Answer

Plasma cells

Answer

Macrophages

Question 6

Malignant form of intraoral acanthosis nigricans is associated with which of the following?

Accepted Answer

Internal malignancy

Answer

External malignancy

Answer

Both internal and external malignancy

Answer

None of the above

Question 7

Which of the following tumors is not caused by PUVA therapy?

Accepted Answer

Cutaneous T-cell lymphoma

Answer

Melanoma

Answer

Basal cell carcinoma (BCC)

Answer

Squamous cell carcinoma (SCC)

Question 8

All are true about squamous cell carcinoma of the skin except?

Accepted Answer

Hematogenous spread is common and occurs early.

Answer

It is called Marjolin's ulcer when it develops in a scar.

Answer

Radiotherapy may be used in its treatment.

Answer

It may develop in a chronic ulcer.

Question 9

Multiple odontogenic keratocysts are associated with which of the following conditions?

Accepted Answer

Gorlin-Goltz syndrome

Answer

Gardner's syndrome

Answer

Goldenhar's syndrome

Answer

Grinspan syndrome

Question 10

Which of the following is NOT a premalignant skin lesion?

Accepted Answer

Miliaria

Answer

Bowen's disease

Answer

Actinic keratoses

Answer

Discoid lupus erythematosus (DLE)

Skin Tumors — MCQs

Skin Tumors — MCQs

On this page

Practice by Chapter

Want unlimited practice?