Skin Tumors Practice Questions

Q: Which of the following is NOT true regarding Kaposi sarcoma?

Occurs exclusively in patients with AIDS. ### Explanation **Kaposi Sarcoma (KS)** is a multicentric angioproliferative tumor caused by **Human Herpesvirus 8 (HHV-8)**. **Why Option D is the Correct Answer (The False Statement):** Kaposi Sarcoma is **not exclusive** to AIDS patients. While the Epidemic (AIDS-associated) variant is the most common today, there are four distinct clinical types: 1. **Classic (European):** Affects elderly men of Mediterranean/Eastern European descent. 2. **Endemic (African):** Occurs in HIV-negative children and adults in Equatorial Africa. 3. **Iatrogenic:** Occurs in solid-organ transplant recipients on immunosuppressants. 4. **Epidemic (AIDS-associated):** The most aggressive form. **Analysis of Other Options:** * **Option A (Predominant in males):** This is true. All forms of KS show a strong male predilection (e.g., the Classic form has a male-to-female ratio of up to 15:1). * **Option B (Multicentric origin):** This is true. KS is not a single primary tumor that metastasizes; rather, it arises from multiple independent foci of vascular endothelial cells simultaneously. * **Option C (Chemotherapy is the treatment of choice):** This is true for disseminated or symptomatic disease. While localized lesions can be treated with radiotherapy or cryotherapy, systemic chemotherapy (e.g., **Liposomal Doxorubicin** or Paclitaxel) is the mainstay for extensive visceral or cutaneous involvement. **High-Yield Clinical Pearls for NEET-PG:** * **Pathology:** Characterized by **spindle-shaped cells**, slit-like vascular spaces, and extravasated RBCs. * **Clinical Stages:** Progresses from **Patch → Plaque → Nodule**. * **Promontory Sign:** A histopathological feature where small vessels protrude into newly formed vascular spaces. * **First-line for AIDS-KS:** Highly Active Antiretroviral Therapy (HAART) often leads to lesion regression.

Q: A 25-year-old female complains of a mole on her upper back. The lesion is 6 mm in diameter, darkly pigmented, and asymmetric, with a very irregular border. What is the next step in management?

Obtain a full-thickness excisional biopsy.. ### Explanation The clinical presentation of this lesion—**asymmetry, irregular borders, dark pigmentation, and a diameter of 6 mm**—fulfills the **ABCDE criteria** for suspected **Malignant Melanoma**. **1. Why Option D is Correct:** When a pigmented lesion is clinically suspicious for melanoma, the gold standard next step is a **full-thickness excisional biopsy** with a narrow margin (usually 1–3 mm). This is crucial because the definitive diagnosis and prognosis of melanoma depend on the **Breslow thickness** (vertical depth of invasion), which can only be accurately measured if the entire architecture of the lesion is preserved. **2. Why Other Options are Incorrect:** * **Option A & B:** "Wait and watch" or merely advising sun protection is dangerous. Melanoma is highly aggressive; delaying diagnosis allows for deeper invasion and a higher risk of metastasis. * **Option C:** A metastatic workup (e.g., CT scans, PET) is premature. Staging investigations are only indicated *after* a histological diagnosis of melanoma is confirmed and the depth of invasion is determined. **3. High-Yield Clinical Pearls for NEET-PG:** * **ABCDE Rule:** **A**symmetry, **B**order irregularity, **C**olor variation, **D**iameter >6 mm, **E**volving/Enlarging. * **Biopsy Technique:** Avoid "shave biopsies" for suspected melanoma, as they may transect the base of the tumor, making it impossible to determine the true Breslow thickness. * **Prognostic Indicator:** **Breslow thickness** is the most important single prognostic factor for cutaneous melanoma. * **Common Site:** In females, the most common site is the **lower legs**; in males, it is the **back**.

Q: A 62-year-old man develops itchy, scaling, and non-scaling patches and plaques over his chest and back. The rest of the examination is normal, except for lymphadenopathy. Examination of the blood film and skin biopsy histology reveal unusually large monocytoid cells. Which of the following is the most likely diagnosis?

Primary cutaneous T-cell lymphoma. **Explanation:** The clinical presentation of itchy, scaling, and non-scaling patches and plaques in an elderly patient, associated with lymphadenopathy and specific histological findings, is classic for **Mycosis Fungoides (MF)**, the most common form of **Primary Cutaneous T-cell Lymphoma (CTCL)**. 1. **Why the correct answer is right:** The "unusually large monocytoid cells" described in the blood film and skin biopsy refer to **Sezary cells** (T-helper cells with cerebriform, folded nuclei). In CTCL, malignant T-lymphocytes migrate to the skin (epidermotropism), forming Pautrier’s microabscesses. The progression from patches to plaques and the involvement of lymph nodes (suggesting advanced stage or Sezary Syndrome) align perfectly with this diagnosis. 2. **Why incorrect options are wrong:** * **Leukemia:** While leukemia can involve the skin (Leukemia cutis), it typically presents as nodules or purpura rather than chronic scaling patches and plaques. * **Visceral B-cell lymphoma:** These usually present with deep-seated nodules or tumors without the superficial "eczema-like" scaling patches characteristic of T-cell skin infiltration. * **Viral infection (EBV):** While EBV is associated with certain lymphomas (like Burkitt’s), it does not typically present with this specific chronic, plaque-like cutaneous morphology or monocytoid T-cell infiltration. **NEET-PG High-Yield Pearls:** * **Pathognomonic sign:** **Pautrier’s microabscesses** (clusters of atypical T-cells in the epidermis). * **Sezary Syndrome Triad:** Erythroderma (exfoliative dermatitis), lymphadenopathy, and >1000/mm³ Sezary cells in peripheral blood. * **Immunophenotype:** Most cases are **CD4+** (T-helper cells). * **Clinical Clue:** Always suspect CTCL in "chronic dermatitis" or "psoriasis" that is refractory to standard treatment in elderly patients.

Q: Squamous cell carcinoma is characterized by which of the following?

Spreads through lymphatics. **Explanation:** **Squamous Cell Carcinoma (SCC)** is a malignant tumor of keratinocytes, typically arising in sun-damaged skin or chronic inflammatory conditions. **Why Option A is Correct:** Unlike Basal Cell Carcinoma (BCC), which is locally invasive but rarely metastasizes, SCC has a significant potential for metastasis. The **primary route of spread for SCC is through the lymphatics** to regional lymph nodes. The risk of metastasis is higher in SCCs arising from chronic ulcers (Marjolin’s ulcer), the lip, the ear, or in immunosuppressed patients. **Analysis of Incorrect Options:** * **Option B (Is radioresistant):** This is incorrect. SCC is generally **radiosensitive**. Radiotherapy is a viable primary treatment for patients who are not surgical candidates or as adjuvant therapy for high-risk lesions. * **Option C (Metastasizes through the bloodstream):** While hematogenous spread can occur in advanced or neglected cases (typically to the lungs), it is not the characteristic or primary mode of spread. Lymphatic spread always precedes hematogenous dissemination in SCC. * **Option D (Surgical excision is contraindicated):** This is incorrect. **Surgical excision** (with predefined margins) or Mohs Micrographic Surgery is the **treatment of choice** for SCC. **High-Yield Clinical Pearls for NEET-PG:** * **Histology:** Look for **"Keratin pearls"** and intercellular bridges (desmosomes). * **Precursor Lesions:** Actinic keratosis (most common) and Bowen’s disease (SCC in-situ). * **Marjolin’s Ulcer:** An aggressive SCC arising in chronic scars or burn sites; it carries a much higher risk of lymphatic metastasis. * **Risk Factors:** UV radiation (most common), HPV (types 16, 18), chronic arsenic exposure, and xeroderma pigmentosum.

Q: Erythroplasia of Queyrat occurs in which anatomical location?

Penis. **Explanation:** **Erythroplasia of Queyrat (EQ)** is a clinical variant of **Squamous Cell Carcinoma in situ (Bowen’s Disease)** that specifically occurs on the **glans penis or the prepuce (inner foreskin)** in uncircumcised men. Histologically, it represents full-thickness dysplasia of the squamous epithelium without invasion into the basement membrane. * **Why Option B is Correct:** The term "Erythroplasia of Queyrat" is reserved for Bowen’s disease involving the **mucosal or transitional surfaces of the penis**. It typically presents as a well-demarcated, velvety, bright red plaque. Chronic irritation, friction, and lack of circumcision are significant risk factors. * **Why Options A, C, and D are Incorrect:** * **Scrotum:** Bowen’s disease on the keratinized skin of the scrotum is simply called "Bowen’s Disease," not EQ. * **Testis/Bladder:** These are internal organs. EQ is a cutaneous/mucosal malignancy of the external genitalia. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bowen’s Disease vs. EQ:** Both are SCC in situ. Bowen’s occurs on sun-exposed or keratinized skin; EQ occurs on the glans penis/prepuce. 2. **Bowenoid Papulosis:** Another differential for penile lesions; it presents as multiple small, brown-to-red papules and is strongly associated with **HPV types 16 and 18**. 3. **Progression:** EQ has a higher rate of progression to invasive Squamous Cell Carcinoma (approx. 10-30%) compared to Bowen’s disease on the skin. 4. **Treatment:** Options include topical 5-Fluorouracil, Imiquimod, or Mohs Micrographic Surgery.

Q: Rodent ulcer is:

Basal cell carcinoma. **Explanation:** **Basal Cell Carcinoma (BCC)** is the most common skin cancer globally. The term **"Rodent Ulcer"** is a classic clinical description for a specific morphological variant of BCC (nodulo-ulcerative type). It is so named because the ulcer appears as if a rodent has "gnawed" into the skin, characterized by a central depression/ulceration surrounded by a raised, pearly, "rolled-out" border with telangiectasia. * **Why Option C is correct:** BCC arises from the basal layer of the epidermis. It is locally invasive and destructive (hence the "gnawing" appearance) but rarely metastasizes. It typically occurs on sun-exposed areas, particularly the upper face (above the line joining the lobe of the ear to the angle of the mouth). * **Why Options A & B are wrong:** A rodent ulcer is a neoplastic process, not an infection (bacterial/fungal) or an immunological hypersensitivity reaction. * **Why Option D is wrong:** While Squamous Cell Carcinoma (SCC) also presents as an ulcer, it typically lacks the characteristic pearly, rolled borders of BCC and has a higher potential for lymphatic metastasis. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site:** Nose (specifically the nasolabial fold). * **Risk Factor:** Chronic UV radiation exposure (UVB). * **Histopathology:** Shows "Peripheral Palisading" of nuclei and "Retraction Artifacts" (clefts between tumor nests and stroma). * **Inherited Syndromes:** Gorlin Syndrome (Basal Cell Nevus Syndrome) – associated with PTCH gene mutation, odontogenic keratocysts, and bifid ribs. * **Treatment of Choice:** Surgical excision; **Mohs Micrographic Surgery** is the gold standard for high-risk areas (face).

Q: Compound nevi with dysplasia are known as:

Clark's nevi. **Explanation:** **Correct Answer: A. Clark’s nevi** Clark’s nevi, also known as **dysplastic nevi** or atypical moles, are acquired melanocytic nevi that exhibit both architectural and cytologic atypia. Histologically, they are typically **compound nevi** (involving both the epidermis and dermis) or junctional nevi that show "bridging" of nests, fibroplasia, and random nuclear pleomorphism. They are clinically significant as they serve as both a potential precursor to and a phenotypic marker for an increased risk of cutaneous melanoma. **Why other options are incorrect:** * **B. Spitz nevi:** These are benign melanocytic proliferations characterized by large, spindle-shaped or epithelioid cells. They are most common in children and are histologically distinct for having **Kamino bodies** (eosinophilic globules), not dysplasia. * **C. Blue nevi:** These are dermal melanocytic lesions where the melanocytes are located deep in the dermis. The blue color is due to the **Tyndall effect**. They do not typically show the dysplastic features associated with Clark’s nevi. **High-Yield Clinical Pearls for NEET-PG:** * **ABCDE Criteria:** Used to clinically screen for dysplasia/melanoma (Asymmetry, Border irregularity, Color variegation, Diameter >6mm, Evolving). * **Ugly Duckling Sign:** A mole that looks significantly different from the patient's other moles is a high-yield clinical indicator for biopsy. * **B-K Mole Syndrome:** Another name for Dysplastic Nevus Syndrome (Autosomal Dominant inheritance). * **Histology Tip:** Look for "bridging" of melanocytic nests between adjacent rete ridges and "lamellar fibroplasia" (concentric fibrosis around the nests) to identify Clark’s nevi in pathology questions.

Q: Which of the following is NOT a feature of keloids?

Never gets worse after 6 months. **Explanation:** The correct answer is **A (Never gets worse after 6 months)** because keloids are characterized by their **persistent, progressive growth**. Unlike hypertrophic scars, which often stabilize or regress after 6 months, keloids continue to expand indefinitely and rarely show spontaneous regression. **Understanding the Options:** * **Option A (Correct):** This statement is false regarding keloids. Keloids frequently continue to grow for years, often extending far beyond the original site of injury. * **Option B (Incorrect):** Severe itching (pruritus) is a hallmark clinical feature of keloids. It is caused by the release of histamine from mast cells within the dense collagenous tissue. * **Option C (Incorrect):** Keloids are often symptomatic; the margins and the body of the lesion are frequently tender or painful due to nerve compression within the thick bundles of Type I and III collagen. **Clinical Pearls for NEET-PG:** * **Definition:** A keloid is an exuberant overgrowth of granulation tissue that **extends beyond the boundaries** of the original wound. * **Histology:** Characterized by thick, eosinophilic, "glassy" **hyalinized collagen bundles** (collagen whorls). * **Common Sites:** Presternal area, earlobes (post-piercing), and deltoid region. * **Treatment:** Intralesional corticosteroids (Triamcinolone acetonide) are the first-line treatment. Surgical excision alone has a high recurrence rate (often >50%) unless combined with adjuvant therapy like radiotherapy or pressure garments. * **Key Differentiator:** Hypertrophic scars stay within the wound margins and often improve over time; keloids invade surrounding healthy skin and do not regress.

Q: All are true about basal cell carcinoma except?

The most common site is acral parts.. **Explanation:** **Basal Cell Carcinoma (BCC)** is the most common skin cancer globally. Understanding its behavior and origin is crucial for NEET-PG. **Why Option D is the Correct Answer (The False Statement):** The most common site for BCC is **sun-exposed areas**, particularly the **face** (specifically the upper two-thirds of the face, above a line joining the lobe of the ear to the corner of the mouth). **Acral parts** (palms and soles) are extremely rare sites for BCC because these areas lack pilosebaceous units, from which BCC is thought to originate. In contrast, Acral Lentiginous Melanoma is the classic malignancy associated with acral sites. **Analysis of Other Options:** * **Option A:** BCC is indeed **locally aggressive**. It is often nicknamed a "rodent ulcer" because, if left untreated, it can invade deeply into local tissues, including muscle and bone. * **Option B:** It is characterized by **slow growth** and an extremely low rate of metastasis (<0.1%). Its morbidity arises from local destruction rather than systemic spread. * **Option C:** The molecular hallmark of BCC is the constitutive activation of the **Hedgehog signaling pathway**, most commonly due to mutations in the **PTCH1 gene** (as seen in Gorlin Syndrome) or the **SMO gene**. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factor:** Chronic UV light exposure is the primary trigger. * **Clinical Presentation:** Classically presents as a pearly, translucent papule with **telangiectasia** and a rolled-out border. * **Histopathology:** Shows "islands" of basaloid cells with **peripheral palisading** and retraction artifacts (clefts). * **Treatment of Choice:** Surgical excision; Mohs micrographic surgery is preferred for high-risk facial areas.

Q: Mycosis fungoides is classified as which type of malignancy?

T cell lymphoma. **Explanation:** **Mycosis Fungoides (MF)** is the most common form of **Cutaneous T-Cell Lymphoma (CTCL)**. It is a low-grade (indolent) extranodal non-Hodgkin lymphoma characterized by the malignant proliferation of skin-homing **CD4+ T-helper cells**. 1. **Why A is correct:** The neoplastic cells in MF are mature, skin-resident T-lymphocytes. Histologically, these cells exhibit "epidermotropism" (migration into the epidermis) and form characteristic clusters known as **Pautrier’s microabscesses**. 2. **Why B and C are incorrect:** While B-cell lymphomas can occur in the skin (e.g., Primary Cutaneous Marginal Zone Lymphoma), MF is strictly a T-cell malignancy. It does not involve a mixture of malignant cell lineages. 3. **Why D is incorrect:** Plasma cell tumors (like Multiple Myeloma or Plasmacytoma) involve terminally differentiated B-cells and present differently, often with bone lesions or monoclonal protein spikes, rather than the classic patch/plaque progression of MF. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Stages:** MF typically progresses through three stages: **Patch → Plaque → Tumor**. * **Sezary Syndrome:** This is the leukemic (systemic) variant of CTCL characterized by the triad of **erythroderma, lymphadenopathy, and atypical circulating T-cells (Sezary cells)** with "cerebriform" nuclei. * **Histology Hallmark:** Pautrier’s microabscesses (pathognomonic) and "Lutzner cells" (cells with indented, brain-like nuclei). * **Treatment:** Early-stage MF is treated with skin-directed therapies like topical steroids, PUVA (phototherapy), or narrow-band UVB.

Question 1

Which of the following is NOT true regarding Kaposi sarcoma?

Accepted Answer

Occurs exclusively in patients with AIDS

Answer

Predominant in males

Answer

Multicentric origin

Answer

Chemotherapy is the treatment of choice

Question 2

A 25-year-old female complains of a mole on her upper back. The lesion is 6 mm in diameter, darkly pigmented, and asymmetric, with a very irregular border. What is the next step in management?

Accepted Answer

Obtain a full-thickness excisional biopsy.

Answer

Advise the patient to avoid sunlight.

Answer

Observe the lesion for any evidence of growth.

Answer

Obtain metastatic workup.

Question 3

A 62-year-old man develops itchy, scaling, and non-scaling patches and plaques over his chest and back. The rest of the examination is normal, except for lymphadenopathy. Examination of the blood film and skin biopsy histology reveal unusually large monocytoid cells. Which of the following is the most likely diagnosis?

Accepted Answer

Primary cutaneous T-cell lymphoma

Answer

Leukemia

Answer

Visceral B-cell lymphoma

Answer

Viral infection (usually Epstein-Barr)

Question 4

Squamous cell carcinoma is characterized by which of the following?

Accepted Answer

Spreads through lymphatics

Answer

Is radioresistant

Answer

Metastasizes through the bloodstream

Answer

Surgical excision is contraindicated

Question 5

Erythroplasia of Queyrat occurs in which anatomical location?

Accepted Answer

Penis

Answer

Scrotum

Answer

Testis

Answer

Bladder

Question 6

Rodent ulcer is:

Accepted Answer

Basal cell carcinoma

Answer

Infectious ulcer

Answer

Hypersensitivity reaction

Answer

Squamous cell carcinoma

Question 7

Compound nevi with dysplasia are known as:

Accepted Answer

Clark's nevi

Answer

Spitz nevi

Answer

Blue nevi

Answer

None of the above

Question 8

Which of the following is NOT a feature of keloids?

Accepted Answer

Never gets worse after 6 months

Answer

Severe itching is present

Answer

Margins are tender

Answer

None of the above

Question 9

All are true about basal cell carcinoma except?

Accepted Answer

The most common site is acral parts.

Answer

It is a locally aggressive tumor.

Answer

It is slow growing and rarely metastasizes.

Answer

It is associated with mutations that activate Hedgehog pathway signaling.

Question 10

Mycosis fungoides is classified as which type of malignancy?

Accepted Answer

T cell lymphoma

Answer

B cell lymphoma

Answer

Mixed cell lymphoma

Answer

Plasma cell tumor

Skin Tumors — MCQs

Skin Tumors — MCQs

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