Skin Tumors Practice Questions

Q: Mycosis fungoides is a type of:

Cutaneous T-cell lymphoma. **Explanation:** **Mycosis Fungoides (MF)** is the most common primary **Cutaneous T-cell Lymphoma (CTCL)**. It is a malignant proliferation of skin-homing **CD4+ T-lymphocytes** (helper T-cells). The disease typically follows a chronic, indolent course, progressing through three classic clinical stages: Patch, Plaque, and Tumor. * **Why Option A is correct:** MF is defined by the infiltration of the epidermis by malignant T-cells, a phenomenon known as **epidermotropism**. These cells often cluster around Langerhans cells to form pathognomonic **Pautrier’s microabscesses**. * **Why Options B and C are incorrect:** MF is exclusively a T-cell malignancy. While B-cell lymphomas can occur in the skin (e.g., Primary Cutaneous Marginal Zone Lymphoma), they represent a distinct category with different histological and clinical profiles. * **Why Option D is incorrect:** MF arises from mature, post-thymic T-cells that have migrated to the skin, not from undifferentiated pluripotent stem cells. **High-Yield Clinical Pearls for NEET-PG:** 1. **Sezary Syndrome:** The leukemic (systemic) variant of CTCL characterized by the triad of erythroderma, lymphadenopathy, and circulating atypical T-cells (Sezary cells with **cerebriform nuclei**). 2. **Histology:** Look for "string of pearls" (lymphocytes lined up along the dermo-epidermal junction) and Pautrier’s microabscesses. 3. **Treatment:** Early-stage MF is treated with skin-directed therapies like topical steroids, PUVA (Phototherapy), or Nitrogen Mustard. Advanced stages may require systemic chemotherapy or Interferon-alpha.

Q: What is the most common site for lentigo maligna melanoma?

Face. **Explanation:** **Lentigo Maligna Melanoma (LMM)** is a subtype of melanoma that arises from a pre-existing **Lentigo Maligna** (melanoma in situ). The primary risk factor for this condition is **cumulative, chronic sun exposure** over many decades. 1. **Why Face is Correct:** Since LMM is directly linked to long-term ultraviolet (UV) radiation damage, it occurs almost exclusively on **sun-exposed areas** of elderly individuals. The **face** (specifically the cheeks and nose) is the most common site, followed by the neck and the dorsum of the hands. It typically presents as a slowly enlarging, variegated brown-to-black macule with irregular borders. 2. **Why Other Options are Incorrect:** * **Legs:** This is the most common site for **Superficial Spreading Melanoma** in females. * **Trunk:** This is the most common site for **Superficial Spreading Melanoma** in males. * **Soles:** This is the characteristic site for **Acral Lentiginous Melanoma**, which is the most common clinical subtype of melanoma in Asians and dark-skinned individuals. **High-Yield Clinical Pearls for NEET-PG:** * **Hutchinson’s Melanotic Freckle:** Another name for Lentigo Maligna. * **Growth Pattern:** LMM has a prolonged **radial growth phase** (often lasting 5–15 years) before entering the vertical growth phase. * **Demographics:** It is most commonly seen in the elderly (6th–7th decade). * **Histopathology:** Characterized by a linear proliferation of atypical melanocytes along the dermo-epidermal junction (lentiginous pattern) with underlying solar elastosis.

Q: Which of the following is NOT true regarding Kaposi sarcoma?

Occurs exclusively in patients with AIDS. ### Explanation **Kaposi Sarcoma (KS)** is a multicentric angioproliferative tumor caused by **Human Herpesvirus 8 (HHV-8)**. **Why Option D is the Correct Answer (The False Statement):** Kaposi Sarcoma is **not exclusive** to AIDS patients. While the Epidemic (AIDS-associated) variant is the most common today, there are four distinct clinical types: 1. **Classic (European):** Affects elderly men of Mediterranean/Eastern European descent. 2. **Endemic (African):** Occurs in HIV-negative children and adults in Equatorial Africa. 3. **Iatrogenic:** Occurs in solid-organ transplant recipients on immunosuppressants. 4. **Epidemic (AIDS-associated):** The most aggressive form. **Analysis of Other Options:** * **Option A (Predominant in males):** This is true. All forms of KS show a strong male predilection (e.g., the Classic form has a male-to-female ratio of up to 15:1). * **Option B (Multicentric origin):** This is true. KS is not a single primary tumor that metastasizes; rather, it arises from multiple independent foci of vascular endothelial cells simultaneously. * **Option C (Chemotherapy is the treatment of choice):** This is true for disseminated or symptomatic disease. While localized lesions can be treated with radiotherapy or cryotherapy, systemic chemotherapy (e.g., **Liposomal Doxorubicin** or Paclitaxel) is the mainstay for extensive visceral or cutaneous involvement. **High-Yield Clinical Pearls for NEET-PG:** * **Pathology:** Characterized by **spindle-shaped cells**, slit-like vascular spaces, and extravasated RBCs. * **Clinical Stages:** Progresses from **Patch → Plaque → Nodule**. * **Promontory Sign:** A histopathological feature where small vessels protrude into newly formed vascular spaces. * **First-line for AIDS-KS:** Highly Active Antiretroviral Therapy (HAART) often leads to lesion regression.

Q: A 25-year-old female complains of a mole on her upper back. The lesion is 6 mm in diameter, darkly pigmented, and asymmetric, with a very irregular border. What is the next step in management?

Obtain a full-thickness excisional biopsy.. ### Explanation The clinical presentation of this lesion—**asymmetry, irregular borders, dark pigmentation, and a diameter of 6 mm**—fulfills the **ABCDE criteria** for suspected **Malignant Melanoma**. **1. Why Option D is Correct:** When a pigmented lesion is clinically suspicious for melanoma, the gold standard next step is a **full-thickness excisional biopsy** with a narrow margin (usually 1–3 mm). This is crucial because the definitive diagnosis and prognosis of melanoma depend on the **Breslow thickness** (vertical depth of invasion), which can only be accurately measured if the entire architecture of the lesion is preserved. **2. Why Other Options are Incorrect:** * **Option A & B:** "Wait and watch" or merely advising sun protection is dangerous. Melanoma is highly aggressive; delaying diagnosis allows for deeper invasion and a higher risk of metastasis. * **Option C:** A metastatic workup (e.g., CT scans, PET) is premature. Staging investigations are only indicated *after* a histological diagnosis of melanoma is confirmed and the depth of invasion is determined. **3. High-Yield Clinical Pearls for NEET-PG:** * **ABCDE Rule:** **A**symmetry, **B**order irregularity, **C**olor variation, **D**iameter >6 mm, **E**volving/Enlarging. * **Biopsy Technique:** Avoid "shave biopsies" for suspected melanoma, as they may transect the base of the tumor, making it impossible to determine the true Breslow thickness. * **Prognostic Indicator:** **Breslow thickness** is the most important single prognostic factor for cutaneous melanoma. * **Common Site:** In females, the most common site is the **lower legs**; in males, it is the **back**.

Q: A 62-year-old man develops itchy, scaling, and non-scaling patches and plaques over his chest and back. The rest of the examination is normal, except for lymphadenopathy. Examination of the blood film and skin biopsy histology reveal unusually large monocytoid cells. Which of the following is the most likely diagnosis?

Primary cutaneous T-cell lymphoma. **Explanation:** The clinical presentation of itchy, scaling, and non-scaling patches and plaques in an elderly patient, associated with lymphadenopathy and specific histological findings, is classic for **Mycosis Fungoides (MF)**, the most common form of **Primary Cutaneous T-cell Lymphoma (CTCL)**. 1. **Why the correct answer is right:** The "unusually large monocytoid cells" described in the blood film and skin biopsy refer to **Sezary cells** (T-helper cells with cerebriform, folded nuclei). In CTCL, malignant T-lymphocytes migrate to the skin (epidermotropism), forming Pautrier’s microabscesses. The progression from patches to plaques and the involvement of lymph nodes (suggesting advanced stage or Sezary Syndrome) align perfectly with this diagnosis. 2. **Why incorrect options are wrong:** * **Leukemia:** While leukemia can involve the skin (Leukemia cutis), it typically presents as nodules or purpura rather than chronic scaling patches and plaques. * **Visceral B-cell lymphoma:** These usually present with deep-seated nodules or tumors without the superficial "eczema-like" scaling patches characteristic of T-cell skin infiltration. * **Viral infection (EBV):** While EBV is associated with certain lymphomas (like Burkitt’s), it does not typically present with this specific chronic, plaque-like cutaneous morphology or monocytoid T-cell infiltration. **NEET-PG High-Yield Pearls:** * **Pathognomonic sign:** **Pautrier’s microabscesses** (clusters of atypical T-cells in the epidermis). * **Sezary Syndrome Triad:** Erythroderma (exfoliative dermatitis), lymphadenopathy, and >1000/mm³ Sezary cells in peripheral blood. * **Immunophenotype:** Most cases are **CD4+** (T-helper cells). * **Clinical Clue:** Always suspect CTCL in "chronic dermatitis" or "psoriasis" that is refractory to standard treatment in elderly patients.

Q: Erythroplasia of Queyrat occurs in which anatomical location?

Penis. **Explanation:** **Erythroplasia of Queyrat (EQ)** is a clinical variant of **Squamous Cell Carcinoma in situ (Bowen’s Disease)** that specifically occurs on the **glans penis or the prepuce (inner foreskin)** in uncircumcised men. Histologically, it represents full-thickness dysplasia of the squamous epithelium without invasion into the basement membrane. * **Why Option B is Correct:** The term "Erythroplasia of Queyrat" is reserved for Bowen’s disease involving the **mucosal or transitional surfaces of the penis**. It typically presents as a well-demarcated, velvety, bright red plaque. Chronic irritation, friction, and lack of circumcision are significant risk factors. * **Why Options A, C, and D are Incorrect:** * **Scrotum:** Bowen’s disease on the keratinized skin of the scrotum is simply called "Bowen’s Disease," not EQ. * **Testis/Bladder:** These are internal organs. EQ is a cutaneous/mucosal malignancy of the external genitalia. **High-Yield Clinical Pearls for NEET-PG:** 1. **Bowen’s Disease vs. EQ:** Both are SCC in situ. Bowen’s occurs on sun-exposed or keratinized skin; EQ occurs on the glans penis/prepuce. 2. **Bowenoid Papulosis:** Another differential for penile lesions; it presents as multiple small, brown-to-red papules and is strongly associated with **HPV types 16 and 18**. 3. **Progression:** EQ has a higher rate of progression to invasive Squamous Cell Carcinoma (approx. 10-30%) compared to Bowen’s disease on the skin. 4. **Treatment:** Options include topical 5-Fluorouracil, Imiquimod, or Mohs Micrographic Surgery.

Question 1

What is the best treatment for capillary nevus?

Accepted Answer

Argon laser treatment

Answer

Full thickness skin graft

Answer

Dermabrasion

Answer

Tattooing

Question 2

A 45-year-old man presented with a 3-year history of a painless, soft, and slow-growing swelling of the neck, upper trunk, upper back, and shoulders. The patient had a history of heavy alcohol consumption and was a non-smoker. Laboratory blood analysis showed minor elevations in aspartate aminotransferase (71 U/L), alanine aminotransferase (49 U/L), and total cholesterol. Triglycerides were elevated at 1,020 mg/dL (11.52 mmol/L). Magnetic resonance imaging revealed diffuse, non-encapsulated fatty deposits in the mediastinum and in the subcutaneous and deeper fascial compartments of the neck, upper trunk, and back. What is the probable diagnosis of the patient?

Accepted Answer

Madelung's disease

Answer

Tuberculosis

Answer

Rheumatoid arthritis

Answer

Hodgkin's lymphoma

Question 3

What is the characteristic histological finding of Leser-Trélat sign?

Accepted Answer

Seborrheic keratosis

Answer

Actinic keratosis

Answer

Basal cell carcinoma

Answer

Squamous cell carcinoma

Question 4

Squamous cell carcinoma can arise from which of the following conditions?

Accepted Answer

Rodent ulcer

Answer

Long standing venous ulcers

Answer

Chronic lupus vulgaris

Answer

All of the above

Question 5

Mycosis fungoides is a type of:

Accepted Answer

Cutaneous T-cell lymphoma

Answer

T-cell and B-cell lymphoma

Answer

B cell lymphoma

Answer

Malignancy derived from stem cells

Question 6

What is the most common site for lentigo maligna melanoma?

Accepted Answer

Face

Answer

Legs

Answer

Trunk

Answer

Soles

Question 7

Which of the following is NOT true regarding Kaposi sarcoma?

Accepted Answer

Occurs exclusively in patients with AIDS

Answer

Predominant in males

Answer

Multicentric origin

Answer

Chemotherapy is the treatment of choice

Question 8

A 25-year-old female complains of a mole on her upper back. The lesion is 6 mm in diameter, darkly pigmented, and asymmetric, with a very irregular border. What is the next step in management?

Accepted Answer

Obtain a full-thickness excisional biopsy.

Answer

Advise the patient to avoid sunlight.

Answer

Observe the lesion for any evidence of growth.

Answer

Obtain metastatic workup.

Question 9

A 62-year-old man develops itchy, scaling, and non-scaling patches and plaques over his chest and back. The rest of the examination is normal, except for lymphadenopathy. Examination of the blood film and skin biopsy histology reveal unusually large monocytoid cells. Which of the following is the most likely diagnosis?

Accepted Answer

Primary cutaneous T-cell lymphoma

Answer

Leukemia

Answer

Visceral B-cell lymphoma

Answer

Viral infection (usually Epstein-Barr)

Question 10

Erythroplasia of Queyrat occurs in which anatomical location?

Accepted Answer

Penis

Answer

Scrotum

Answer

Testis

Answer

Bladder

Skin Tumors — MCQs

Skin Tumors — MCQs

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