Non-melanoma skin cancers — MCQs

A 72-year-old man presents to the clinic for the evaluation of a lesion on his nose that has been slowly getting larger for the past 2 months. The patient notes no history of trauma, pruritus, or pain, but states that the size of the lesion is making his nose feel uncomfortable. On exam, the nodule is pink with rolled borders. Telangiectasias are also present within the lesion, with central ulceration. What is the characteristic histologic appearance of this lesion?

A 34-year-old man presents to the office for evaluation of a lesion on his upper arm that appeared a few months ago and has not healed. The patient appears healthful but has a history of cardiovascular disease. He states that his friend at the industrial ammunition factory where he works told him he should "get it looked at." The patient admits to some nausea, vomiting, and diarrhea over the past year, but he states that he "feels fine now." On physical examination, the lesion is an erythematous, scaly, ulcerated plaque on the flexor surface of his upper arm. The rest of the exam is within normal limits. What is the most likely diagnosis?

A 61-year-old Caucasian male presents to your office complaining of morning headaches of 6 weeks duration. A head MRI reveals a likely metastasis of unknown origin in the supratentorial region of the brain. On biopsy, the neoplastic mass is shown to have a mutation in BRAF, a protein kinase, in which a glutamic acid is substituted for valine at position 600 of the protein. Where did this metastasis most likely originate?

A 72-year-old man comes to the physician because of a lesion on his eyelid for 6 months. The lesion is not painful or pruritic. He initially dismissed it as a 'skin tag' but the lesion has increased in size over the past 3 months. He has type 2 diabetes mellitus, coronary artery disease, and left hemiplegia from a stroke 3 years ago. Current medications include sitagliptin, metformin, aspirin, and simvastatin. He used to work as a construction contractor and retired 3 years ago. Examination shows a 1-cm (0.4-in) flesh-colored, nodular, nontender lesion with rolled borders. There is no lymphadenopathy. Cardiopulmonary examination shows no abnormalities. Muscle strength is reduced in the left upper and lower extremities. Visual acuity is 20/20. The pupils are equal and reactive to light. A shave biopsy confirms the diagnosis of basal cell carcinoma. Which of the following is the most appropriate next step in management?

A 62-year-old woman comes to the physician for evaluation of a mole on her forearm that has increased in size over the last several months. Physical examination shows a 9-mm skin lesion on the right forearm with irregular borders. An excisional biopsy is performed, and genetic analysis shows a mutation in the gene that encodes B-Raf. Which of the following cellular events most likely predisposed this patient to developing this skin lesion?

A 38-year-old woman applies a PABA sunscreen to her skin before going to the beach. Which type(s) of ultraviolet light will it protect her against?

A 49-year-old woman presents to her physician with complaints of breast swelling and redness of the skin over her right breast for the past 1 month. She also mentions that the skin above her right breast appears to have thickened. She denies any pain or nipple discharge. The past medical history is significant for a total abdominal hysterectomy at 45 years of age. Her last mammogram 1 year ago was negative for any pathologic changes. On examination, the right breast was diffusely erythematous with gross edema and tenderness and appeared larger than the left breast. The right nipple was retracted and the right breast was warmer than the left breast. No localized mass was palpated. Which of the following statements best describes the patient’s most likely condition?

A 12-year-old boy is brought to the emergency department after he vomited and said he was having double vision in school. He also says that he has been experiencing morning headaches, nausea, and dizziness over the last month. He has no past medical history and is not taking any medications. Physical exam reveals a broad-based gait, dysmetria on finger-to-nose testing, and nystagmus. Both serum and urine toxicology are negative, and radiography reveals a solid mass in the midline cerebellum that enhances after contrast administration. Biopsy of this lesion reveals cells of primitive neuroectodermal origin. Which of the following would most likely be seen on histology of this lesion?

A 50-year-old woman with rheumatoid arthritis on methotrexate develops rapidly progressive painful ulcers on her legs with violaceous undermined borders. Biopsy shows neutrophilic dermal infiltrate with areas of necrosis, but no vasculitis or infection. Wound cultures are negative. Despite debridement, the ulcers worsen. C-ANCA and P-ANCA are negative. Evaluate the diagnosis and determine the management that addresses both the cutaneous condition and systemic disease.

A 25-year-old woman presents with painful oral ulcers and a pustular rash at venipuncture sites. She has genital ulcers and a history of recurrent uveitis. Skin biopsy from a pustule shows neutrophilic infiltrate in the dermis without vasculitis or infection. HLA-B51 testing is positive. She is planning pregnancy. Evaluate the management strategy considering disease control and pregnancy planning.