INI-CET 2017 - Dermatology Practice Questions

Q: A patient presents with ulcer on the side of the nose, as shown, which bleeds on itching. What is the diagnosis? (AIIMS Nov 2017)

Basal cell carcinoma. ***Basal cell carcinoma*** - The image shows a **pearly appearance** with a **central ulceration** and **rolled borders**, which are classic clinical features of **nodular basal cell carcinoma**. - **Bleeding upon minor trauma or itching** (friability) is also a common characteristic of basal cell carcinoma, especially the ulcerated form. *Squamous cell carcinoma* - Squamous cell carcinoma typically presents as a **crusted, firm, red nodule** or a **patch with scales and ulceration**, often in sun-exposed areas. - While it can ulcerate and bleed, it usually lacks the distinct **pearly appearance and rolled borders** seen in basal cell carcinoma. *Marjolin ulcer* - A Marjolin ulcer is a **malignant degeneration of a chronic ulcer**, burn scar, or chronic inflammatory lesion, most commonly an aggressive squamous cell carcinoma. - It would present in the context of a **pre-existing long-standing lesion** or scar, which is not indicated here, and generally has a more irregular, indurated appearance. *Nevus* - A nevus (mole) is a benign growth of pigment-producing cells which typically presents as a **well-demarcated pigmented lesion**. - While some nevi can be raised or irregular, they generally do **not ulcerate spontaneously or bleed easily** on scratching unless traumatized, nor do they typically have the pearly, rolled borders of a basal cell carcinoma.

Q: A female had a thorn prick 5 years ago. She presents with development of slowly growing $2 \times 2 \mathrm{~cm}$ verrucous lesion which on KOH mount shows the following image. Diagnosis is: (AIIMS Nov 2017)

Chromoblastomycosis. ***Chromoblastomycosis*** - The image shows **sclerotic bodies** (also known as **Medlar bodies**, muriform cells, or fumagoid cells) which are characteristic of *Chromoblastomycosis*. These are thick-walled, septate, dematiaceous (darkly pigmented) fungal cells that reproduce by septation in multiple planes. - The history of a **thorn prick** (trauma allowing inoculation of fungal spores from soil/vegetation), the **slowly growing verrucous lesion**, and the presence of sclerotic bodies on KOH mount are all highly specific for chromoblastomycosis. *Sporotrichosis* - **Sporotrichosis** typically presents with subcutaneous nodules that ulcerate, often forming a **lymphocutaneous spread** along lymphatic vessels. - On microscopy (KOH mount or biopsy), *Sporothrix schenckii* appears as **cigar-shaped budding yeasts** in tissue, which are not seen in the provided image. *Blastomycosis* - **Blastomycosis** is caused by *Blastomyces dermatitidis* and can cause pulmonary, cutaneous, and disseminated infections. Cutaneous lesions can be verrucous but are typically granulomatous with microabscesses. - Microscopic examination (KOH mount) reveals **large, broad-based budding yeast cells**, which are distinct from the sclerotic bodies shown. *Phaeohyphomycosis* - **Phaeohyphomycosis** encompasses a diverse group of infections caused by dematiaceous (pigmented) fungi that, in tissue, grow as **septate hyphae**, yeast-like cells, or a combination of both, but **do not form sclerotic bodies**. - While it can manifest as subcutaneous nodules or cysts, the diagnostic feature in tissue is the presence of pigmented hyphal forms, unlike the characteristic sclerotic bodies in the image.

Question 1

A patient presents with ulcer on the side of the nose, as shown, which bleeds on itching. What is the diagnosis? (AIIMS Nov 2017)

Accepted Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Answer

Marjolin ulcer

Answer

Nevus

Question 2

A female had a thorn prick 5 years ago. She presents with development of slowly growing $2 	imes 2 \mathrm{~cm}$ verrucous lesion which on KOH mount shows the following image. Diagnosis is: (AIIMS Nov 2017)

Accepted Answer

Chromoblastomycosis

Answer

Sporotrichosis

Answer

Blastomycosis

Answer

Phaeohyphomycosis

INI-CET 2017 — Dermatology