Skin Tumors Practice Questions

Q: What is the most common location for extramammary Paget's disease in women?

Vulva and perianal area. ***Vulva*** - Extramammary Paget's disease predominantly occurs in the **vulvar region**, where it manifests as **red, scaly lesions** [1]. - It is associated with **apocrine gland** involvement and may show underlying malignancy in some cases. *Ovary* - The ovaries are not typical locations for **Extramammary Paget's disease**, as it primarily affects surface epithelium rather than **internal structures**. - Any lesions in the ovaries would raise suspicion for different **pathologies**, such as ovarian tumors, rather than Paget's disease. *Vagina* - Paget's disease does not commonly affect the vagina [1]; it is more associated with **external genitalia** like the vulva. - Vaginal lesions would likely indicate other conditions such as **vaginal carcinoma** or other inflammatory processes. *Uterus* - The uterus is not a site for **Extramammary Paget's disease**; this condition is specific to areas with **apocrine glands**. - Uterine issues are generally related to different diseases, such as **endometrial cancer** or **leiomyoma**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Female Genital Tract, p. 1004.

Q: Mycosis fungoides primarily involves which type of immune cell?

T lymphocytes. ***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.

Q: Which of the following are risk factors for cutaneous lymphoma?

All of the options. ***All of the options*** - **All listed factors**, including age, gender, and a weakened immune system, are recognized risk factors for the development of cutaneous lymphoma. - The risk of cutaneous lymphoma generally **increases with age**, shows a slightly higher incidence in **males**, and is significantly elevated in individuals with **compromised immune systems**. *Age* - While age is a risk factor, it is only one component among several that contribute to the overall risk of developing cutaneous lymphoma. - The incidence of most lymphomas, including cutaneous forms, typically **increases with advancing age**, but other factors also play a critical role. *Gender* - Like age, gender is a recognized risk factor, with a slightly **higher incidence in males** compared to females. - However, gender alone does not fully explain the risk, as environmental and other host-related factors also contribute. *Weakened immune system* - A weakened immune system is a significant risk factor, as it impairs the body's ability to control abnormal cell growth, including cancerous lymphocytes. - However, it is not the sole risk factor; individuals with healthy immune systems can also develop cutaneous lymphoma due to other contributing factors.

Q: A giant congenital melanocytic nevus is usually of what size?

20 cm or greater. ***20 cm or greater*** - A **giant congenital melanocytic nevus (GCMN)** is defined by its substantial size, typically measuring **20 cm or more in diameter** in an adult. - This large size is a key feature distinguishing it from smaller congenital nevi and is associated with a **higher risk of malignant transformation** and neurological complications such as **neurocutaneous melanosis**. *5-10cm* - A nevus of this size would be classified as a **small to medium congenital melanocytic nevus**, not a giant one. - While these nevi carry some risk of malignancy, it is significantly **lower than that of GCMN**. *10-15 cm* - This range falls under the category of a **medium congenital melanocytic nevus**. - While larger than small nevi, it does not meet the established criteria for a **giant congenital melanocytic nevus**. *15-20 cm* - A nevus of 15-20 cm is considered a **large congenital melanocytic nevus**, but it is still usually classified just below the threshold for a true **giant congenital melanocytic nevus** which is typically 20 cm or more. - Although it approaches the giant classification, the **20 cm demarcation** is critical for defining GCMN.

Q: Which melanoma subtype has the worst prognosis?

Nodular melanoma. ***Nodular melanoma*** - This subtype has the **worst prognosis** among melanoma subtypes due to its aggressive growth pattern. - It exhibits **vertical growth from the outset** with no radial growth phase, leading to rapid deep invasion. - Typically presents at a more advanced stage with greater **Breslow thickness** at diagnosis. - High metastatic potential and rapid progression contribute to poorer survival rates. *Acral lentiginous melanoma* - Occurs on **palms, soles, and subungual areas** and is more common in darker-skinned populations. - Poor outcomes are primarily due to **delayed diagnosis** and late presentation rather than inherently aggressive biology. - When diagnosed at comparable stages, prognosis is similar to other melanoma subtypes. *Superficial spreading melanoma* - The **most common melanoma subtype** (60-70% of cases). - Has a prolonged **horizontal (radial) growth phase** before vertical invasion. - Generally better prognosis due to longer period allowing for **early detection and treatment**. *Lentigo maligna melanoma* - Occurs on **chronically sun-damaged skin**, typically on the face and neck of elderly patients. - Has a prolonged **in situ phase** (lentigo maligna) before invasive melanoma develops. - Generally has a **better prognosis** when detected and treated during the in situ phase.

Q: For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?

Mohs surgery. ***Mohs surgery*** - **Mohs micrographic surgery** is the most popular and highly effective procedure specifically designed for **basal cell carcinoma (BCC)**, especially on the face and other cosmetically sensitive areas. - It involves the **progressive removal** of thin layers of skin, which are immediately examined under a microscope, allowing for complete tumor removal while preserving maximum healthy tissue. - Mohs surgery has the **highest cure rate** (95-99%) for BCC and is particularly preferred for high-risk locations, recurrent tumors, and poorly defined borders. *Superficial laser surgery* - While lasers can sometimes be used for very superficial skin lesions, **superficial laser surgery** is generally not the primary treatment for established **BCC** due to the risk of incomplete removal and recurrence. - It lacks the **histological margin control** provided by Mohs surgery, which is crucial for ensuring complete eradication of BCC. *Curettage and electrodesiccation* - **Curettage and electrodesiccation** is an alternative surgical treatment for small, low-risk BCCs in non-critical areas. - However, it has **lower cure rates** (85-95%) compared to Mohs surgery and does not provide histological margin assessment. - It is less preferred for facial BCCs where cosmetic outcome and complete removal are critical. *Wide local excision* - **Wide local excision** is a standard surgical approach that removes the tumor with predetermined margins (typically 4-5 mm for BCC). - While effective, it requires **larger tissue removal** compared to Mohs surgery and lacks the real-time microscopic margin control. - Mohs surgery remains more popular due to its tissue-sparing nature and higher cure rates, especially in cosmetically sensitive areas.

Q: Which of the following nevus types is most commonly associated with malignant melanoma development?

Dysplastic nevus. ***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.

Q: Actinic keratoses are associated with

Squamous cell carcinoma (SCC). ***Squamous cell carcinoma (SCC)*** - **Actinic keratoses** are considered a **premalignant lesion** and are the most common precursor to invasive cutaneous SCC. - They represent **atypical keratinocytes** that have the potential to progress to SCC, particularly with continued sun exposure. *Basal cell carcinoma (BCC)* - While BCC is also a **sun-related skin cancer**, it typically develops de novo and is **not directly associated** with actinic keratoses as a precursor. - BCC usually arises from the **basal layer of the epidermis** or hair follicles, unlike SCC which originates from keratinocytes. *Malignant melanoma* - **Melanoma** originates from **melanocytes**, not keratinocytes, and is not associated with actinic keratoses. - Its precursors include **dysplastic nevi** or de novo development, distinct from the epidermal changes seen in actinic keratosis. *Keratoacanthoma* - **Keratoacanthoma** is a rapidly growing, dome-shaped tumor that can resemble SCC, and some consider it a **low-grade SCC variant**. - While it may share some features with SCC, actinic keratoses are more broadly recognized as precursors directly to typical invasive SCC rather than specifically to keratoacanthoma.

Q: Which of the following nevi has the highest risk of malignant transformation to melanoma?

Congenital nevus. ***Junctional nevus*** - Junctional nevi are located at the **epidermal-dermal junction** and have a higher potential for **malignant transformation into melanoma** compared to other types of nevi [1,2]. - They often present as flat, pigmented lesions, making them distinguishable and more likely to undergo **dysplastic changes** associated with melanoma [1,4]. *Dermal nevus* - Dermal nevi are located deeper in the **dermis** and have a **lower risk** of transformation into melanoma [2]. - They are usually dome-shaped and lack the architectural changes that indicate a potential for malignancy [3]. *Lentigo nevus* - Lentigo nevi are generally benign pigmented lesions that result from **increased melanocyte activity** and are not typically associated with melanoma. - Although they can appear in sun-exposed areas, their risk for malignant transformation remains **minimal**. *Congenital nevus* - Congenital nevi can vary in size and may have some potential for **melanoma transformation**, but this risk is generally lower than that for junctional nevi. - Larger congenital nevi have a higher risk, yet they do not specifically relate to **common malignant transformation** compared to junctional nevi. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Skin, pp. 1146-1150. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 649-650. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 648-649.

Question 1

What is the most common location for extramammary Paget's disease in women?

Accepted Answer

Vulva and perianal area

Answer

Uterine cervix and endometrium

Answer

Breast tissue only

Answer

Ovary and fallopian tubes

Question 2

Mycosis fungoides primarily involves which type of immune cell?

Accepted Answer

T lymphocytes

Answer

NK cells

Answer

B lymphocytes

Answer

Plasma cells

Question 3

Which of the following statements about Mycosis fungoides is not true?

Accepted Answer

It has an indolent course but is not easily amenable to treatment.

Answer

Pautrier's microabscesses are characteristic histopathological features

Answer

It is the most common form of cutaneous lymphoma

Answer

Erythroderma is seen and it spreads to peripheral circulation

Question 4

Which of the following are risk factors for cutaneous lymphoma?

Accepted Answer

All of the options

Answer

Weakened immune system

Answer

Age

Answer

Gender

Question 5

A giant congenital melanocytic nevus is usually of what size?

Accepted Answer

20 cm or greater

Answer

5-10cm

Answer

10-15 cm

Answer

15-20 cm

Question 6

Which melanoma subtype has the worst prognosis?

Accepted Answer

Nodular melanoma

Answer

Superficial spreading

Answer

Lentigo maligna melanoma

Answer

Acral lentiginous melanoma

Question 7

For the treatment of basal cell carcinoma, what is the popular surgery that is carried out?

Accepted Answer

Mohs surgery

Answer

Superficial laser surgery

Answer

Curettage and electrodesiccation

Answer

Wide local excision

Question 8

Which of the following nevus types is most commonly associated with malignant melanoma development?

Accepted Answer

Dysplastic nevus

Answer

Junctional nevus

Answer

Intradermal nevus

Answer

Blue nevus

Question 9

Actinic keratoses are associated with

Accepted Answer

Squamous cell carcinoma (SCC)

Answer

Keratoacanthoma

Answer

Basal cell carcinoma (BCC)

Answer

Malignant melanoma

Question 10

Which of the following nevi has the highest risk of malignant transformation to melanoma?

Accepted Answer

Congenital nevus

Answer

Dermal nevus

Answer

Junctional nevus

Answer

Lentigo nevus

Skin Tumors — MCQs

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