Skin Tumors 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: What is true regarding the picture shown below?

All these options are true. ***All these options are true*** - The image depicts a severe case of **basal cell carcinoma (BCC)**, exhibiting features consistent with its advanced stages, such as significant ulceration and tissue destruction. - All the statements in the preceding options accurately describe characteristics of BCC and are medically correct. *This is basal cell carcinoma which arises from the basal layer of keratinocytes* - **Basal cell carcinoma (BCC)** is the most common form of skin cancer, originating from the **basal keratinocytes** of the epidermis. - The image shows a **destructive lesion** on the ear, consistent with an advanced basal cell carcinoma, with characteristic ulceration and tissue destruction. - BCC arises from the basal layer of the epidermis, which consists of proliferative keratinocytes. *Rodent ulcer appearance* - The term **"rodent ulcer"** describes an aggressive, infiltrative, and destructive form of basal cell carcinoma that erodes skin and underlying tissues, often with central ulceration and raised, pearly borders. - The lesion in the image shows significant **tissue destruction and ulceration**, which is highly characteristic of a rodent ulcer. - This term is classically used for advanced, neglected BCC that appears to have been "gnawed" by a rodent. *Exposure to solar UV radiation is a risk factor* - **Exposure to ultraviolet (UV) radiation**, primarily from sunlight, is the leading risk factor for the development of basal cell carcinoma, especially in sun-exposed areas like the ear, face, and neck. - Chronic sun exposure causes **DNA damage** in basal keratinocytes, leading to mutations in genes like PTCH1 and activation of the hedgehog signaling pathway. - Other risk factors include fair skin, ionizing radiation, immunosuppression, and arsenic exposure.

Q: What is true regarding the picture shown below?

All these options are true. ***All these options are true*** - The image depicts a **malignant lesion on the ear**, characterized by extensive tissue destruction and ulceration. This appearance is highly consistent with advanced **basal cell carcinoma (BCC)**, especially the aggressive, infiltrative type. - As all the preceding statements describe characteristic features of basal cell carcinoma, and the image is consistent with this diagnosis, this option correctly synthesizes the validity of the individual choices. *This is basal cell carcinoma which arises from the basal layer of keratinocytes* - The image shown, with its destructive ulceration and typical location on the ear (a sun-exposed area), is highly suggestive of advanced **basal cell carcinoma (BCC)**. - **BCC** originates from the **basal keratinocytes of the epidermis**, which are the proliferative cells in the basal layer that give rise to the overlying epidermis. - BCC is the most common skin cancer and typically presents on sun-exposed areas with various morphological patterns. *Rodent ulcer appearance* - The term "**rodent ulcer**" is a classical description for an advanced, ulcerative form of **basal cell carcinoma**. - This appearance is characterized by a **central ulceration** with rolled, pearly borders and often presents with extensive local destruction, as seen in the image. *Exposure to solar UV radiation is a risk factor* - **Ultraviolet (UV) radiation from sun exposure** is the primary and most significant **environmental risk factor** for the development of basal cell carcinoma. - BCC commonly occurs on **sun-exposed areas** such as the face, ears, neck, and hands, reinforcing the link to UV radiation.

Q: The image given below shows:

Cutaneous horn. ***Cutaneous horn (Cornu cutaneum)*** - The image distinctly shows an **exophytic, conical, or cylindrical lesion** composed of compact keratin, resembling an animal's horn, which is characteristic of a cutaneous horn. - A cutaneous horn is a **clinical descriptive term** for a keratinous projection and is NOT of sebaceous origin; it can arise from various underlying conditions including **seborrheic keratosis, viral warts, actinic keratosis**, or benign lesions. - Importantly, cutaneous horns can rarely **harbor squamous cell carcinoma** or other underlying skin cancers at their base (up to 20% have underlying malignancy), necessitating biopsy and histopathological examination. *Papilloma* - A papilloma is a general term for a **benign epithelial tumor** growing exophytically in a frond-like or papillary pattern, often softer and not typically forming such a dense, hardened projection. - While some papillomas can be keratotic, they usually lack the extreme **horn-like appearance** made of densely packed keratin seen in the image. *Cock's peculiar tumor* - Cock's peculiar tumor, also known as a **calcifying epithelioma of Malherbe** or **pilomatricoma**, is typically a firm, deep-seated nodule arising from hair matrix cells, often with a bluish or reddish hue. - It does not present as a **hard, projecting, horn-like accumulation of keratin** on the skin surface. *Glomus tumor* - A glomus tumor is a rare, **benign neurovascular tumor** typically found in the digits (especially subungual), characterized by exquisite pain, cold sensitivity, and often present as a small, reddish-blue nodule. - Its presentation is distinctly different from the **hyperkeratotic cutaneous projection** shown and does not form a horn-like structure.

Q: A 30-year-old construction worker had a partial traumatic nail avulsion. 3 weeks later he presents with the presentation shown below. What is the diagnosis?

Pyogenic granuloma. ***Pyogenic granuloma*** - The image shows a **fleshy, red, often ulcerated nodule** following a partial traumatic nail avulsion, which is highly characteristic of a pyogenic granuloma. - These lesions are **reactive vascular proliferations** that typically develop rapidly at sites of trauma or inflammation. *Pyoderma gangrenosum* - Pyoderma gangrenosum characteristically presents as a rapidly enlarging, painful **ulcer with violaceous undermined borders** and often a purulent base, which differs from the described lesion. - It is typically associated with **systemic diseases**, such as inflammatory bowel disease or hematologic malignancies, and does not typically present as a focal, exophytic growth after localized trauma. *Pott's puffy tumor* - Pott's puffy tumor is a subperiosteal abscess of the frontal bone, usually caused by sinusitis, leading to a **forehead swelling** with osteomyelitis and epidural abscess. - This condition involves the **skull** and brain, not the nail bed, and presents with different clinical features like fever, headache, and periorbital edema. *Acute paronychia* - Acute paronychia is an **infection of the nail fold**, presenting with pain, redness, and swelling around the nail, often with pus accumulation. - While it can follow minor trauma, it is characterized by **inflammatory signs of infection** in the paronychial area, not a rapidly growing, exuberant granulation-like tissue as shown.

Q: What is the diagnosis based on the clinical image shown?

Plexiform neurofibroma. ***Plexiform neurofibroma*** - The image displays numerous **nodular, flesh-colored to hyperpigmented lesions** predominantly on the face, characteristic of **plexiform neurofibromas**, which are often present in **Neurofibromatosis type 1 (NF1)**. - These lesions are typically soft, sometimes described as feeling like a "bag of worms" on palpation, due to the proliferation of neural tissue, and can cause significant disfigurement. *Proteus syndrome* - Proteus syndrome is characterized by **overgrowth of various tissues**, bones, and organs, leading to asymmetric and disproportionate growth. - While it can involve skin lesions such as **cerebriform connective tissue nevi**, the appearance in the image with diffuse, multiple, distinct neurofibroma-like nodules does not align with the typical presentation of Proteus syndrome. *Cruveilhier-Baumgarten disease* - This is a rare condition characterized by the presence of an **umbilical caput medusae** (dilated veins radiating from the umbilicus), due to portal hypertension with a patent umbilical vein not seen in the image. - It relates to circulatory abnormalities in the abdomen and does not present with cutaneous lesions as shown in the image. *Dermal neurofibroma* - While dermal neurofibromas are benign nerve sheath tumors that can occur on the skin, they are typically **discrete, solitary, or few in number**, often presenting as soft, sessile or pedunculated lesions. - The extensive, diffuse, and nodular appearance across the entire face in the image suggests a more widespread and deeply intertwined growth pattern characteristic of **plexiform neurofibromas**, rather than isolated dermal neurofibromas.

Q: The following image shows presence of:

Angiofibroma, Peri-ungual fibroma. ***Angiofibroma, Peri-ungual fibroma*** - The image on the left shows facial **angiofibromas**, characterized by small, reddish-brown papules predominantly on the central face, butterfly distribution on the nose, and cheeks. - The image on the right displays **peri-ungual fibromas** (Koenen tumors), which are flesh-colored growths emerging from under the nail fold, typically seen in tuberous sclerosis. *Angiokeratoma, Peri-ungual warts* - **Angiokeratomas** are usually dark red to blue-black papules with a rough hyperkeratotic surface, often found on the scrotum, vulva, or trunk, which doesn't match the facial lesions. - **Peri-ungual warts** are caused by HPV and appear as cauliflower-like growths, often with black dots (thrombosed capillaries), which differ from the smooth, firm peri-ungual fibromas shown. *Angiosarcoma, Peri-ungual lupus* - **Angiosarcoma** is a rare and aggressive vascular tumor, typically appearing as bruise-like lesions or plaques that can ulcerate; it does not resemble the benign facial growths. - **Peri-ungual lupus** would likely present with signs of inflammation, telangiectases, and nail dystrophy associated with autoimmune disease, not discrete fibrous growths. *Angiolipoma, peri-ungual fibroma* - **Angiolipomas** are benign tumors composed of fat and blood vessels, typically presenting as subcutaneous nodules that can be painful, but they are not characteristic facial lesions like those seen. - While peri-ungual fibromas are correctly identified, the facial lesions are not angiolipomas but rather angiofibromas.

Q: The image shows presence of:

Syringoma. ***Correct: Syringoma*** - Syringomas are **benign adnexal tumors** derived from the eccrine sweat ducts, often appearing as **small, flesh-colored to yellowish papules**, commonly around the eyes or on the face, as seen in the image. - They are typically asymptomatic but can be numerous and persistent. - Histologically, they show **comma-like or tadpole-shaped ducts** in the dermis. *Incorrect: Cutaneous horn* - A cutaneous horn is a **conical projection** of keratin from the skin, often hard and yellowish, resembling an animal's horn, which is not depicted in the image. - It can be associated with underlying benign, premalignant, or malignant lesions. *Incorrect: Acrochordon* - Acrochordons, or **skin tags**, are soft, flesh-colored, pedunculated growths that typically appear in areas of friction like the neck, axilla, or groin. - The lesions in the image are small, firm papules, not soft, pendulous structures. *Incorrect: Keratoacanthoma* - Keratoacanthomas are **rapidly growing, dome-shaped nodules** with a central keratin plug, often appearing on sun-exposed skin. - They have a characteristic crater-like appearance with rolled edges, which is distinct from the lesions in the image.

Q: A 50-year-old patient presents with lesion over the nose with rapid growth for last 6 weeks. He has no past history of any skin disease. The image shows presence of?

Keratoacanthoma. ***Keratoacanthoma*** - Keratoacanthomas are characterized by **rapid growth** over weeks to months, forming a **dome-shaped nodule with a central keratotic plug**, often resembling a volcano. - While generally considered benign, they share morphological and histological features with squamous cell carcinoma, making differentiation crucial. *Seborrheic keratosis* - Seborrheic keratosis typically presents as a **well-demarcated, waxy, 'pasted-on' lesion** that grows slowly over years. - They are usually flat or slightly raised with a finely fissured or verrucous surface, not a rapidly growing nodule with a central crater. *Syringoma* - Syringomas are **benign eccrine sweat duct tumors** that appear as small (1-3 mm) skin-colored or yellowish papules, often found around the eyelids. - They do not exhibit rapid growth or the characteristic central crater seen in the image. *Cutaneous horn* - A cutaneous horn is a **clinical description** of a conical, hyperkeratotic lesion, but it is not a specific diagnosis; rather, it indicates the presence of an underlying pathology like an actinic keratosis, squamous cell carcinoma, or warts. - While it can appear on the nose, the rapid growth and dome shape with a central crater are more indicative of a keratoacanthoma than a generic cutaneous horn.

Q: A 70-year-old man presents with an ulcerative lesion over the forehead. A biopsy was performed. All are true about the condition shown except?

Pautrier's micro-abscess formation. ***Pautrier's micro-abscess formation*** - Pautrier's micro-abscesses are characteristic findings in **Mycosis fungoides (cutaneous T-cell lymphoma)**, which is not depicted here. - The image and description are consistent with basal cell carcinoma, where these micro-abscesses do not occur. *Basaloid cell nests extending into epidermis* - The biopsy image shows nests of **basaloid cells** extending downwards from the epidermis, which is a classic histopathological feature of **basal cell carcinoma**. - These nests often exhibit peripheral palisading and retraction artifact, distinguishing features of this common skin cancer. *Locally destructive* - **Basal cell carcinoma** is known for its **local invasiveness and destructive growth pattern**, often eroding surrounding tissues. - While it rarely metastasizes, its local destruction can cause significant morbidity, especially on the face. *Does not metastasize usually* - **Basal cell carcinoma has a very low metastatic potential**, making it distinct from many other malignancies. - Metastasis is exceedingly rare, occurring in less than 0.1% of cases, though local recurrence is common if not completely excised.

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

What is true regarding the picture shown below?

Accepted Answer

All these options are true

Answer

This is basal cell carcinoma which arises from the basal layer of keratinocytes

Answer

Rodent ulcer appearance

Answer

Exposure to solar UV radiation is a risk factor

Question 3

What is true regarding the picture shown below?

Accepted Answer

All these options are true

Answer

This is basal cell carcinoma which arises from the basal layer of keratinocytes

Answer

Rodent ulcer appearance

Answer

Exposure to solar UV radiation is a risk factor

Question 4

The image given below shows:

Accepted Answer

Cutaneous horn

Answer

Papilloma

Answer

Cock's peculiar tumor

Answer

Glomus tumor

Question 5

A 30-year-old construction worker had a partial traumatic nail avulsion. 3 weeks later he presents with the presentation shown below. What is the diagnosis?

Accepted Answer

Pyogenic granuloma

Answer

Pyoderma gangrenosum

Answer

Pott's puffy tumor

Answer

Acute paronychia

Question 6

What is the diagnosis based on the clinical image shown?

Accepted Answer

Plexiform neurofibroma

Answer

Proteus syndrome

Answer

Cruveilhier-Baumgarten disease

Answer

Dermal neurofibroma

Question 7

The following image shows presence of:

Accepted Answer

Angiofibroma, Peri-ungual fibroma

Answer

Angiokeratoma, Peri-ungual warts

Answer

Angiosarcoma, Peri-ungual lupus

Answer

Angiolipoma, Peri-ungual fibroma

Question 8

The image shows presence of:

Accepted Answer

Syringoma

Answer

Cutaneous horn

Answer

Acrochordon

Answer

Keratoacanthoma

Question 9

A 50-year-old patient presents with lesion over the nose with rapid growth for last 6 weeks. He has no past history of any skin disease. The image shows presence of?

Accepted Answer

Keratoacanthoma

Answer

Seborrheic keratosis

Answer

Syringoma

Answer

Cutaneous horn

Question 10

A 70-year-old man presents with an ulcerative lesion over the forehead. A biopsy was performed. All are true about the condition shown except?

Accepted Answer

Pautrier's micro-abscess formation

Answer

Basaloid cell nests extending into epidermis

Answer

Locally destructive

Answer

Does not metastasize usually

Skin Tumors — MCQs

Skin Tumors — MCQs

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