Skin Cancer Prevention and Screening — MCQs
Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:
Which of the following attributes are essential for an ideal screening test?
Most cost effective approach for the prevention of non-communicable disease is by -
Which of the following nevus types is most commonly associated with malignant melanoma development?
All of the following hereditary conditions predispose to central nervous system tumors, except.
A patient presents with a skin rash that is exaggerated on sun exposure. What is the repair mechanism involved in this condition?
Rodent ulcer is
Mycosis fungoides primarily involves which type of immune cell?
A farmer presented with a black mole on the cheek. It increased in size, more than 6mm with irregular borders and a central black lesion, what could be the diagnosis?
National Cancer Control Programme (NCCP) in India was launched in
Skin Cancer Prevention and Screening Indian Medical PG Practice Questions and MCQs
Question 1: Elderly man with a long-standing mole on his face that is increasing in size and showing an irregular border. Diagnosis:
- A. Superficial spreading melanoma
- B. Nodular melanoma
- C. Acral melanoma
- D. Lentigo maligna (Correct Answer)
Explanation: ***Lentigo maligna*** - This type of melanoma commonly affects **elderly individuals** and presents as a **slowly enlarging, irregularly bordered, flat or slightly raised pigmented lesion** on sun-exposed areas like the face. - It often has a **long radial growth phase** before progressing to invasive lentigo maligna melanoma. *Superficial spreading melanoma* - While common, it typically presents on the **trunk or extremities** and has a faster growth rate compared to lentigo maligna. - It often appears as a **flat, asymmetrical lesion with varied colors and irregular borders**, but the age and location details point away from this. *Nodular melanoma* - This is an **aggressive form** that grows vertically from the start, presenting as a **dark, raised, often ulcerated nodule** and typically has a shorter history of rapid growth. - It lacks the characteristic long-standing, flat growth pattern described in the elderly patient's face. *Acral melanoma* - This rare type occurs on the **palms, soles, or under the nails (subungual)**, not typically on the face. - It often appears as a **pigmented streak or patch** in these acral locations.
Question 2: Which of the following attributes are essential for an ideal screening test?
- A. Safe
- B. Reliable
- C. Valid
- D. All of the options (Correct Answer)
Explanation: ***All of the options*** - An ideal screening test must possess **all three essential attributes**: safety, reliability, and validity. - **Safe**: Minimizes harm to participants and ensures ethical implementation - **Reliable**: Produces consistent, reproducible results with minimal random error - **Valid**: Accurately measures what it intends to measure (high sensitivity and specificity) - These three attributes work together as fundamental requirements for any effective screening program, ensuring that early detection benefits outweigh potential risks. *Safe (alone)* - While safety is absolutely essential, it is **not sufficient by itself** to make an ideal screening test. - A test that is safe but unreliable or invalid would produce inconsistent or inaccurate results, rendering it ineffective for screening purposes. *Reliable (alone)* - Reliability ensures consistent results, which is crucial, but **reliability alone is insufficient**. - A test can be highly reliable (consistently giving the same result) yet completely invalid if it measures the wrong thing or is unsafe. *Valid (alone)* - Validity is critical for accurate measurement, but **validity alone does not make a test ideal**. - Even a valid test must be safe to protect participants and reliable to ensure consistency across different settings and times.
Question 3: Most cost effective approach for the prevention of non-communicable disease is by -
- A. Primary prevention
- B. Specific protection
- C. Secondary prevention
- D. Primordial prevention (Correct Answer)
Explanation: ***Primordial prevention*** - This level of prevention targets the **root causes** of risk factors, preventing their emergence in the first place through societal-level interventions. - By shaping healthy environments and promoting healthy lifestyles from birth, it can avert the development of NCDs across entire populations, making it the **most cost-effective** long-term strategy. *Primary prevention* - This involves preventing the onset of disease in healthy individuals by controlling existing risk factors through measures like **vaccination** and health education. - While effective, it addresses risk factors once they exist, which is less cost-effective than preventing their initial emergence through primordial approaches. *Specific protection* - This is a subset of **primary prevention** focused on specific measures to protect against disease, such as immunizations or wearing protective gear. - It's effective for targeted diseases but does not address the broader societal determinants of health as comprehensively as primordial prevention. *Secondary prevention* - This aims to **detect and treat diseases early** to prevent complications and progression, such as through screening programs and early treatment. - While crucial for improving outcomes once a disease has begun, it is inherently more costly than preventing the disease from ever occurring.
Question 4: Which of the following nevus types is most commonly associated with malignant melanoma development?
- A. Junctional nevus
- B. Intradermal nevus
- C. Blue nevus
- D. Dysplastic nevus (Correct Answer)
Explanation: ***Dysplastic nevus*** (Correct) - **Dysplastic nevi** are considered precursor lesions and markers for increased risk of developing **malignant melanoma**. - Individuals with multiple dysplastic nevi have a significantly higher lifetime risk of melanoma compared to the general population. - Also known as **atypical nevi**, they show architectural disorder and cytologic atypia on histology. *Junctional nevus* (Incorrect) - **Junctional nevi** are benign moles with melanocytes located at the **dermo-epidermal junction**. - While theoretically a melanoma can arise from any nevus, junctional nevi are less frequently associated with melanoma development than dysplastic nevi. *Intradermal nevus* (Incorrect) - **Intradermal nevi** are benign moles where the melanocytes are located entirely within the **dermis**. - These nevi are generally stable, often appearing flesh-colored or light brown, and have a very low potential for malignant transformation. *Blue nevus* (Incorrect) - **Blue nevi** are benign lesions characterized by **deeply situated dermal melanocytes** that produce a blue or blue-black color due to the Tyndall effect. - They are typically stable and have a very low risk of malignant transformation; however, rarely, an atypical blue nevus or cellular blue nevus can undergo malignant change.
Question 5: All of the following hereditary conditions predispose to central nervous system tumors, except.
- A. Neurofibromatosis 1 & 2
- B. Von-Hippel-Lindau syndrome
- C. Xeroderma pigmentosum (Correct Answer)
- D. Tuberous sclerosis
Explanation: ***Xeroderma pigmentosum*** - This condition primarily predisposes individuals to **skin cancers** due to defects in DNA repair mechanisms, rather than to central nervous system tumors. - **Neurological complications** can occur, but they are not associated with an increased risk of CNS tumors. *Neurofibromatosis 1 & 2* - Both types are well known for a strong association with **central nervous system tumors** [2][3], particularly **gliomas** and **meningiomas**. - Neurofibromatosis type 1 is especially linked with **optic pathway gliomas**, observable in pediatric patients. *Von-Hippel-Lindau syndrome* - This syndrome is associated with **hemangioblastomas** in the CNS [2][4], particularly in the **cerebellum** and **spinal cord** [4]. - Also predisposes to other tumors, including **renal cell carcinoma** and pancreatic neuroendocrine tumors. *Tuberous sclerosis* - Patients often develop **subependymal giant cell astrocytomas** and other brain tumors due to this condition [1][2]. - Additionally, it can lead to the formation of **hamartomas** in various organs, including the brain [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1318-1319. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 724-725. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Central Nervous System, pp. 1319-1320. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Manifestations Of Central And Peripheral Nervous System Disease, pp. 726-727.
Question 6: A patient presents with a skin rash that is exaggerated on sun exposure. What is the repair mechanism involved in this condition?
- A. Nucleotide excision repair (Correct Answer)
- B. Base excision repair
- C. Mismatch repair
- D. Double stranded DNA break repair
Explanation: ***Nucleotide excision repair*** - This mechanism is responsible for repairing **bulky lesions** in DNA, such as **pyrimidine dimers** caused by **UV radiation** from sun exposure. - Patients with defects in nucleotide excision repair (e.g., **xeroderma pigmentosum**) are highly sensitive to sunlight and develop skin rashes, pigment changes, and skin cancers. *Base excision repair* - This pathway primarily corrects **small damaged bases** that do not cause significant distortion of the DNA helix, such as deaminated, oxidized, or alkylated bases. - It does not primarily address the bulky lesions induced by UV light that cause exaggerated sun sensitivity. *Mismatch repair* - This system corrects errors, like **mismatched base pairs**, that are incorporated during DNA replication. - It is not directly involved in repairing DNA damage caused by environmental factors like UV radiation. *Double stranded DNA break repair* - This mechanism repairs **double-strand breaks** in DNA, which are highly deleterious lesions caused by ionizing radiation or oxidative stress. - While critical for genome stability, it is not the primary repair pathway for UV-induced DNA lesions or the direct cause of sun sensitivity.
Question 7: 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 8: Mycosis fungoides primarily involves which type of immune cell?
- A. NK cells
- B. B lymphocytes
- C. Plasma cells
- D. T lymphocytes (Correct Answer)
Explanation: ***CD4+ T Cells*** - Mycosis fungoides is a type of **cutaneous T-cell lymphoma**, primarily involving **CD4+ T cells** which infiltrate the skin [1][2]. - The disease is characterized by **pleomorphic** skin lesions caused by **malignant T-cell proliferation** [3]. *K Cells (not primarily involved in mycosis fungoides)* - K Cells are involved in **immunological responses** but are not specifically linked to mycosis fungoides. - They do not play a primary role in **cutaneous lymphoproliferative disorders**. *B Cells (involved in humoral immunity)* - B Cells are mainly responsible for **antibody production**, which is not the primary mechanism in mycosis fungoides. - The condition involves **T cell malignancy**, rather than abnormalities in B cell function. *NK Cells (part of innate immunity)* - NK Cells are important for **innate immunity** and target viral and tumor cells but are not primarily involved in this lymphoma. - Mycosis fungoides is characterized by **T cell-mediated responses**, not NK cell activity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 613-614. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, p. 1162. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 564-565.
Question 9: A farmer presented with a black mole on the cheek. It increased in size, more than 6mm with irregular borders and a central black lesion, what could be the diagnosis?
- A. Superficial spreading melanoma (Correct Answer)
- B. Acral lentigo melanoma
- C. Lentigo maligna melanoma
- D. Nodular melanoma
Explanation: ***Superficial spreading melanoma*** - This is the most common type of melanoma and often presents as a **mole with irregular borders**, varying colors, and a diameter greater than 6mm, consistent with the description. - The lesion typically grows **radially** across the skin surface before beginning vertical growth, indicated by the increase in size. *Acral lentigo melanoma* - This type of melanoma primarily affects the **palms, soles, and nail beds**, which is inconsistent with a lesion on the cheek. - It often appears as a **dark brown or black patch** that slowly enlarges, but its location is characteristic. *Lentigo maligna melanoma* - This melanoma typically occurs in **chronically sun-damaged skin** of the elderly, often on the head and neck, but usually presents as a **flat, irregularly shaped, tan or brown patch** with varying shades, which may not fit the description of a central black lesion within a larger mole. - It has a dominant **radial growth phase** and progresses slowly over many years before developing a nodular component. *Nodular melanoma* - This type is characterized by its **rapid vertical growth** and appearance as a **raised, dark, often dome-shaped lesion** from the outset. - While it can be black, the description of an "increased in size" mole with irregular borders and a central black lesion points more towards a spreading type rather than a rapidly growing nodule from the beginning.
Question 10: National Cancer Control Programme (NCCP) in India was launched in
- A. 1992
- B. 1970
- C. 1976 (Correct Answer)
- D. 1986
Explanation: ***1976*** - The **National Cancer Control Programme (NCCP)** was officially launched in India in **1976**. - Its primary objective was to provide comprehensive cancer care services, focusing on prevention, early detection, diagnosis, treatment, and palliation. *1992* - While significant revisions and expansions to the NCCP occurred in **1992**, this was not its initial launch year. - The **1992 modifications** focused on decentralization and integrating cancer control activities into primary healthcare. *1970* - The year **1970** does not mark the official launch of a national cancer control program in India. - Prior to 1976, some fragmented efforts existed, but not a unified national program. *1986* - **1986** saw further strengthening and refinement of the NCCP, but it was not the year of its inception. - This period involved efforts to enhance infrastructure and human resources for cancer care.
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