Skin Tumors Practice Questions

Q: A 60-year-old male presents with a rough, scaly plaque on his forehead that has been slowly enlarging. What is the most likely diagnosis?

Actinic keratosis. ***Actinic keratosis*** - This presents as a **rough, scaly plaque** on sun-exposed areas like the forehead, which is characteristic of actinic keratosis. - Actinic keratoses are considered **premalignant lesions** with the potential to progress to squamous cell carcinoma. *Basal cell carcinoma* - Typically presents as a **pearly papule** with rolled borders and telangiectasias, or sometimes as an ulcerated lesion. - While it occurs on sun-exposed areas, the description of a **rough, scaly plaque** is less typical for classic basal cell carcinoma. *Melanoma* - Often presents with features associated with the **ABCDEs** (Asymmetry, Border irregularity, Color variability, Diameter >6mm, Evolving). - While it can be scaly, the primary concern for melanoma is its pigmentary changes and infiltrative growth, not just a rough plaque. *Seborrheic keratosis* - Characterized by a **"stuck-on" appearance**, often waxy or greasy, with well-demarcated borders and horn cysts (pseudohorn cysts). - While benign and common in older individuals, the description of a rough, scaly plaque is more indicative of a sun-damaged lesion rather than a seborrheic keratosis.

Q: Which of the following statements about Kaposi sarcoma is true?

Lesions are dark blue or purple. ***Lesions are dark blue or purple*** - **Kaposi sarcoma (KS)** lesions are characteristically **violaceous** or **dark blue/purple** due to blood vessel proliferation and extravasated red blood cells. - This distinct coloration is a key diagnostic feature, especially in later stages of the disease when the lesions have become more nodular or plaquelike. *The most common site is the scalp* - The most common sites for KS lesions are typically the **skin of the lower extremities**, followed by the face, trunk, and oral cavity. - While KS can occur on the scalp, it is not the most common primary site of presentation. *They are usually unifocal* - KS is often a **multifocal disease**, meaning lesions can appear in multiple locations simultaneously or sequentially. - The disease arises from the systemic spread of **HHV-8 infection**, rather than a single point of origin, leading to disseminated lesions. *Lymph nodes are never involved* - **Lymph node involvement** is common in KS, especially in the **AIDS-related** form and in regions with high endemic KS, like Africa. - Lymphadenopathy due to KS indicates more widespread disease and can affect prognosis.

Q: 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?

Squamous cell carcinoma. ***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.

Q: A 65-year-old male presents with a new-onset lesion on the scalp that bleeds easily when touched. The lesion appears pearly with telangiectasias. Analyze the clinical features to determine the most likely diagnosis.

Basal cell carcinoma. ***Basal cell carcinoma*** - This is the most common type of skin cancer and classically presents as a **pearly (translucent) nodule** with **telangiectasias** (fine blood vessels) that may **bleed easily**. - It often appears on sun-exposed areas like the scalp and grows slowly, typically not metastasizing. *Squamous cell carcinoma* - Often presents as a **red, scaly patch, nodule, or ulcer** that may be tender and grow rapidly. - While it can bleed easily, it usually lacks the classic pearly appearance and prominent telangiectasias of BCC. *Actinic keratosis* - These are **pre-cancerous lesions** that appear as **rough, scaly, sandpaper-like patches** on sun-damaged skin. - While they can progress to squamous cell carcinoma, they are typically flat and do not present as pearly nodules that bleed easily. *Seborrheic keratosis* - These are **benign, waxy, "stuck-on" appearing lesions** that vary in color from light tan to dark brown or black. - They are usually non-bleeding and lack the pearly appearance and telangiectasias characteristic of BCC.

Q: A 70-year-old man presents with non-healing, pearly nodules on his face. What is the most likely diagnosis?

Basal cell carcinoma. ***Basal cell carcinoma*** - **Pearly nodules** with **non-healing** characteristics, especially on the face, are classic signs of **basal cell carcinoma**. - It's the most common type of skin cancer and often presents as a slowly growing lesion with **telangiectatic vessels**. *Squamous cell carcinoma* - Typically presents as a **red, scaly patch** or **firm, elevated nodule** with a scaly or crusted surface, often with ulceration. - While it can be non-healing and located on the face, it lacks the characteristic pearly appearance of BCC. *Actinic keratosis* - These are **pre-malignant lesions** characterized by rough, scaly patches on sun-exposed areas. - They are not typically described as pearly nodules and may eventually progress to squamous cell carcinoma. *Melanoma* - Characterized by changes in **size, shape, color, or a new lesion** that is often asymmetrical with irregular borders and color variation. - Melanomas rarely present as pearly nodules and are typically pigmented, though amelanotic melanomas exist.

Q: What is the most common type of cutaneous mastocytosis?

Urticaria pigmentosa. ***Urticaria pigmentosa*** - This is the **most common form** of cutaneous mastocytosis, especially in children, accounting for approximately 80% of cases. - It presents as multiple small, tan to reddish-brown macules or papules that **urticate** (swell and itch) upon rubbing (**Darier's sign**). *Solitary mastocytoma* - This is the **second most common** variant, typically presenting as a single nodule or plaque, often appearing in infancy. - While common in infants, it is not as prevalent as generalized urticaria pigmentosa. *Telangiectasia macularis eruptiva perstans* - This is a rare form of cutaneous mastocytosis characterized by persistent telangiectatic macules, more common in adults. - It does not involve the widespread urticarial lesions seen in the most common variant. *Diffuse erythrodermic mastocytosis* - This is a **very rare and severe** form, often presenting in infancy with widespread erythroderma and blistering. - It is associated with a higher risk of systemic involvement and is not the most common presentation.

Q: Acral lentiginous type of malignant melanoma occurs in -

Palms, soles, and nail beds. ***Palms, soles, and nail beds*** - **Acral lentiginous melanoma** specifically occurs on the **palms, soles, and under the nails (nail beds)**, often presenting as a dark streak or lesion. - It is a subtype of melanoma that is **not related to sun exposure** and is more common in individuals with darker skin tones. *Facial regions* - Melanomas on facial regions are often **lentigo maligna melanoma**, which typically develops in chronically **sun-damaged skin**. - This subtype presents as a slow-growing, flat, and irregularly pigmented lesion on the face of older individuals. *Nuchal areas* - The nuchal area (back of the neck) can be affected by various types of melanoma, but it is not a characteristic location for **acral lentiginous melanoma**. - Melanomas here are often related to **intermittent sun exposure** or can be **superficial spreading melanoma**. *Sun-exposed skin areas* - While most melanomas (e.g., superficial spreading melanoma and nodular melanoma) are associated with **sun exposure**, acral lentiginous melanoma is a notable exception. - Melanomas in sun-exposed areas typically present on the trunk, head, and extremities, but not specifically on the palms, soles, or nail beds.

Q: Visual examination is used as a screening test for skin cancer in adults. Among the following skin lesions/cancers, which is considered most important to detect through this visual screening method?

Melanoma. ***Melanoma*** - **Melanoma** is the most aggressive and life-threatening form of skin cancer, with a high metastatic potential if not detected early. - Visual screening is crucial for identifying suspicious lesions (e.g., asymmetrical, irregular borders, varied color, large diameter, evolving) to facilitate early diagnosis and intervention, which significantly improves prognosis. *Basal cell carcinoma* - **Basal cell carcinoma (BCC)** is the most common type of skin cancer but generally grows slowly and rarely metastasizes, making it less urgent for early detection through mass screening compared to melanoma. - While visual screening can detect BCC, its slower progression means that delays in detection typically have less severe consequences than with melanoma. *Squamous cell carcinoma* - **Squamous cell carcinoma (SCC)** is the second most common skin cancer, with a higher metastatic potential than BCC but generally lower than melanoma. - Although important to detect, SCC often progresses over a longer period than melanoma, making early detection via visual screening critical but not as immediately life-saving on a population scale as it is for melanoma. *Actinic keratosis* - **Actinic keratosis (AK)** is a pre-cancerous lesion that can progress to squamous cell carcinoma, but most AKs do not become cancerous. - While visual screening can identify AKs, they are not cancer themselves, and their detection is geared towards prevention rather than immediate cancer treatment, making them less critical for initial screening focus compared to melanoma.

Q: 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?

Basal cell carcinoma. ***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 1

A 60-year-old male presents with a rough, scaly plaque on his forehead that has been slowly enlarging. What is the most likely diagnosis?

Accepted Answer

Actinic keratosis

Answer

Basal cell carcinoma

Answer

Melanoma

Answer

Seborrheic keratosis

Question 2

Which of the following statements about Kaposi sarcoma is true?

Accepted Answer

Lesions are dark blue or purple

Answer

They are usually unifocal

Answer

The most common site is the scalp

Answer

Lymph nodes are never involved

Question 3

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?

Accepted Answer

Squamous cell carcinoma

Answer

Basal cell carcinoma

Answer

Actinic keratosis

Answer

Lichen planus

Question 4

A 65-year-old male presents with a new-onset lesion on the scalp that bleeds easily when touched. The lesion appears pearly with telangiectasias. Analyze the clinical features to determine the most likely diagnosis.

Accepted Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Actinic keratosis

Answer

Seborrheic keratosis

Question 5

A 38-year-old man presents with a solitary, firm, raised, reddish nodule on his back that has gradually increased in size over the past 8 months. Which condition is most likely?

Accepted Answer

Squamous cell carcinoma

Answer

Dermatofibroma

Answer

Mycosis fungoides

Answer

Basal cell carcinoma

Question 6

A 70-year-old man presents with non-healing, pearly nodules on his face. What is the most likely diagnosis?

Accepted Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Actinic keratosis

Answer

Melanoma

Question 7

What is the most common type of cutaneous mastocytosis?

Accepted Answer

Urticaria pigmentosa

Answer

Solitary mastocytoma

Answer

Telangiectasia macularis eruptiva perstans

Answer

Diffuse erythrodermic mastocytosis

Question 8

Acral lentiginous type of malignant melanoma occurs in -

Accepted Answer

Palms, soles, and nail beds

Answer

Facial regions

Answer

Nuchal areas

Answer

Sun-exposed skin areas

Question 9

Visual examination is used as a screening test for skin cancer in adults. Among the following skin lesions/cancers, which is considered most important to detect through this visual screening method?

Accepted Answer

Melanoma

Answer

Actinic keratosis

Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Question 10

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?

Accepted Answer

Basal cell carcinoma

Answer

Melanoma

Answer

Squamous cell carcinoma

Answer

Nevus

Skin Tumors — MCQs

Skin Tumors — MCQs

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