Skin Tumors Practice Questions

Q: An 8-year-old girl presents with numerous hypopigmented, ulcerated, and crusted patches on her face and forearms, as well as an indurated, crater-like skin nodule on the back of her left hand. Biopsy of this skin nodule reveals a squamous cell carcinoma. Molecular biology studies show that this patient has germline mutations in the gene encoding a nucleotide excision repair enzyme. What is the most likely diagnosis?

Xeroderma pigmentosum. ### Explanation **Correct Option: D. Xeroderma pigmentosum (XP)** **Mechanism:** Xeroderma pigmentosum is an autosomal recessive disorder characterized by a defect in **Nucleotide Excision Repair (NER)**. Normally, NER enzymes identify and repair DNA damage (specifically pyrimidine dimers) caused by Ultraviolet (UV) radiation. In XP, this repair mechanism is deficient, leading to the accumulation of mutations. **Clinical Correlation:** The patient exhibits classic features: * **Photosensitivity:** Hypopigmented and hyperpigmented patches (poikiloderma) in sun-exposed areas. * **Early Malignancy:** A 1000-fold increased risk of skin cancers. Developing **Squamous Cell Carcinoma (SCC)** at age 8 is highly characteristic of XP, as these tumors typically appear in the first decade of life. --- ### Why Other Options are Incorrect: * **A. Ataxia telangiectasia:** Caused by mutations in the *ATM* gene (DNA double-strand break repair). It presents with cerebellar ataxia, oculocutaneous telangiectasia, and immunodeficiency, not early-onset SCC. * **B. Hereditary albinism:** Due to a defect in melanin synthesis (tyrosinase deficiency). While these patients are prone to skin cancer due to lack of photoprotection, they do not have a primary defect in the NER enzyme system. * **C. Li-Fraumeni syndrome:** Caused by germline mutations in the *TP53* tumor suppressor gene. It leads to a broad spectrum of early-onset cancers (sarcomas, breast cancer, brain tumors), but not the specific UV-induced skin phenotype seen here. --- ### NEET-PG High-Yield Pearls: * **Inheritance:** Autosomal Recessive. * **Most common cause of death:** Metastatic Squamous Cell Carcinoma or Melanoma. * **Neurological involvement:** Seen in **De Sanctis-Cacchione syndrome** (a severe variant of XP). * **Key Enzyme Defect:** UV-specific endonuclease (involved in NER). * **Eye findings:** Photophobia, keratitis, and corneal opacities are common.

Q: A 50-year-old construction worker with a history of tobacco use for 20 years presents with a growth on his lower lip. Biopsy confirms a carcinoma. What is the most likely cancer?

Squamous cell carcinoma. **Explanation:** The correct answer is **Squamous Cell Carcinoma (SCC)**. **Why SCC is correct:** Squamous Cell Carcinoma is the most common malignancy of the **lower lip**. The primary risk factors in this patient—**chronic sun exposure** (due to his occupation as a construction worker) and **tobacco use**—are classic triggers for SCC. In the oral region, SCC typically arises from precursor lesions like actinic cheilitis or leukoplakia. While Basal Cell Carcinoma (BCC) is the most common skin cancer overall, it follows the "rule of the line" (joining the tragus to the angle of the mouth), making it more common on the **upper lip**, whereas SCC dominates the lower lip. **Why other options are incorrect:** * **Basal Cell Carcinoma:** Though common on sun-exposed skin, it rarely affects mucosal surfaces and is significantly more common on the **upper lip**. * **Malignant Melanoma:** While it can occur on the lips (mucosal melanoma), it is much rarer than SCC and usually presents as a pigmented, irregular lesion rather than a standard growth. * **Verrucous Carcinoma:** This is a low-grade variant of SCC (Ackerman’s tumor). While associated with smokeless tobacco (snuff), it is less common than conventional SCC and typically presents as a slow-growing, cauliflower-like warty mass. **NEET-PG High-Yield Pearls:** * **Lip Rule:** Upper Lip = BCC; Lower Lip = SCC. * **Most common site for SCC:** Lower lip (due to UV exposure). * **Most common site for BCC:** Nose (inner canthus). * **Marjolin’s Ulcer:** SCC arising in a chronic cicatrix (scar) or long-standing ulcer. * **Histology:** Look for "Keratin pearls" and "Intercellular bridges" for SCC diagnosis.

Q: Buschke-Löwenstein tumor is associated with which of the following?

Malignant transformation in an anogenital wart. **Explanation:** **Buschke-Löwenstein tumor (BLT)**, also known as **Giant Condyloma Acuminatum**, is a rare, slow-growing, but locally aggressive tumor. It is considered a form of **Verrucous Carcinoma**, a low-grade squamous cell carcinoma. 1. **Why the correct answer is right:** BLT is primarily associated with **Human Papillomavirus (HPV) types 6 and 11**. It typically arises from long-standing **anogenital warts** (Condyloma Acuminata). While it rarely metastasizes, it is characterized by massive size, deep local infiltration into underlying tissues, and a high rate of recurrence. The transformation from a benign wart to this destructive "cauliflower-like" mass defines its clinical significance. 2. **Why the incorrect options are wrong:** * **Option A & C:** Plantar warts (Verruca plantaris) and common warts (Verruca vulgaris) are caused by different HPV strains (e.g., HPV 1, 2, 4). While they can occasionally undergo malignant change (e.g., Cuniculatum carcinoma on the sole), they are not the origin of Buschke-Löwenstein tumors. * **Option D:** Seborrheic warts (Seborrheic Keratosis) are benign epidermal proliferations not caused by HPV. They are not associated with BLT. 3. **Clinical Pearls for NEET-PG:** * **Histology:** Shows "pushing" rather than "infiltrative" borders. * **Treatment of Choice:** Wide local surgical excision. * **Risk Factors:** Immunosuppression (HIV, organ transplant) and poor hygiene. * **Key Association:** Remember the triad: **HPV 6/11 + Anogenital site + Locally invasive but non-metastasizing.**

Q: Papillomatous tongue is observed in which of the following conditions?

Lymphangioma. **Explanation:** **Lymphangioma circumscriptum** is a benign malformation of the lymphatic vessels. When it involves the tongue (Macroglossia), it typically presents as a cluster of clear, fluid-filled vesicles that resemble "frog spawn." Over time, these vesicles can become hyperkeratotic and verrucous, leading to a characteristic **papillomatous or pebbly appearance** of the tongue surface. This is the most common cause of macroglossia in children. **Analysis of Incorrect Options:** * **Systemic hyalinosis (Infantile Systemic Hyalinosis):** This is characterized by the deposition of hyaline material in the skin and internal organs. While it causes thickened skin and gingival hyperplasia, it does not typically present with a papillomatous tongue. * **Foetal face syndrome (Robinow Syndrome):** This genetic disorder is characterized by short-limbed dwarfism and facial dysmorphism (resembling a 8-week-old fetus). Oral findings usually include gingival hypertrophy and a wide mouth, but not papillomatous lesions. * **Tuberous sclerosis:** While this neurocutaneous syndrome presents with oral manifestations like **gingival fibromas** and **dental enamel pitting**, it is not associated with a papillomatous tongue. **High-Yield Clinical Pearls for NEET-PG:** * **Lymphangioma circumscriptum:** Often described as "frog-spawn" appearance; histologically shows dilated lymphatic channels in the papillary dermis. * **Macroglossia Differential:** Common causes include Down syndrome, Hemangioma, Lymphangioma, and Hypothyroidism (Cretinism). * **Cobblestone Tongue:** Seen in Crohn’s disease and Amyloidosis. * **Strawberry Tongue:** White strawberry tongue (early) and Red strawberry tongue (late) are classic signs of **Scarlet Fever** and **Kawasaki Disease**.

Q: Bowen's disease is:

An intraepithelial carcinoma. **Explanation:** **Bowen’s disease** is a form of **Squamous Cell Carcinoma (SCC) in situ**. The term "in situ" or "intraepithelial" signifies that the malignant keratinocytes are confined to the epidermis and have not breached the dermo-epidermal junction (basement membrane). 1. **Why Option B is correct:** Bowen’s disease represents the full-thickness dysplasia of the epidermis. Histologically, it is characterized by "windblown" appearance (disordered keratinocytes), pleomorphism, and frequent mitoses, but the basement membrane remains intact. If left untreated, it can progress to invasive Squamous Cell Carcinoma. 2. **Why other options are incorrect:** * **Options A & D:** Bowen’s disease is primarily a cutaneous (skin) condition. While it can occur on mucosal surfaces (where it is often termed Erythroplasia of Queyrat when on the glans penis), it is not a primary neoplasm or ulcerative lesion of the Gastrointestinal Tract (G.I.T). * **Option C:** It typically presents as a slow-growing, well-demarcated, erythematous, scaly plaque. It is not a vesiculobullous (blistering) lesion. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Often mistaken for psoriasis or eczema, but it does not respond to topical steroids. * **Etiology:** Chronic UV exposure, Arsenic ingestion (look for "raindrop pigmentation" on the trunk), and High-risk HPV types (especially HPV 16). * **Erythroplasia of Queyrat:** This is the specific name for Bowen’s disease occurring on the glans penis or prepuce. * **Treatment of Choice:** Surgical excision, though topical 5-Fluorouracil (5-FU), Imiquimod, or Cryotherapy are also used.

Q: An HIV-positive patient presents with a characteristic appearance of the leg and a history of HHV-8 infection. What is the most likely diagnosis?

Kaposi sarcoma. ***Kaposi sarcoma*** - **HHV-8 (Human herpesvirus-8)** is the causative agent of Kaposi sarcoma, particularly in **HIV-positive patients** with immunosuppression. - Presents with characteristic **violaceous (purple-red) plaques or nodules** on the legs and other sites, which matches the described appearance. *Lymphoma* - While HIV patients have increased risk of lymphomas, **HHV-8 infection** is not typically associated with most lymphoma types. - Lymphomas usually present as **enlarged lymph nodes** or systemic B-symptoms, not characteristic leg lesions. *Malignant melanoma* - **Not associated with HHV-8 infection** and occurs independently of HIV status in most cases. - Typically presents as an **asymmetric, irregularly bordered pigmented lesion** that changes over time, not the violaceous appearance described. *Non-Hodgkin's lymphoma* - Although **HIV patients** have increased NHL risk, it is **not specifically linked to HHV-8** infection. - Usually presents with **lymphadenopathy**, hepatosplenomegaly, or extranodal masses, not characteristic skin lesions on legs.

Q: Which of the following is a precancerous condition of the skin?

Bowen disease. **Explanation:** **Bowen disease** is the correct answer because it represents **Squamous Cell Carcinoma (SCC) in situ**. This means malignant keratinocytes are confined to the epidermis and have not yet breached the dermo-epidermal junction. If left untreated, approximately 3–5% of cases progress to invasive Squamous Cell Carcinoma, making it a classic precancerous condition. Clinically, it presents as a slow-growing, well-demarcated, erythematous scaly plaque, often mimicking eczema or psoriasis. **Analysis of Incorrect Options:** * **Seborrhoeic keratosis:** This is a common **benign** epidermal tumor ("stucco keratosis"). It has no malignant potential. A sudden eruption of multiple seborrheic keratoses (Leser-Trélat sign) can, however, be a paraneoplastic sign of internal malignancy (usually GI adenocarcinoma). * **Leprosy:** This is a chronic infectious disease caused by *Mycobacterium leprae*. While chronic trophic ulcers in leprosy can rarely undergo malignant transformation (Marjolin’s ulcer), the disease itself is inflammatory/infectious, not precancerous. * **Psoriasis:** This is a chronic T-cell mediated inflammatory autoimmune condition. There is no inherent increased risk of skin cancer from the disease itself, though long-term PUVA therapy used to treat it can increase SCC risk. **High-Yield Clinical Pearls for NEET-PG:** * **Other Precancerous Conditions:** Actinic keratosis (most common), Erythroplasia of Queyrat (Bowen’s of the glans penis), and Leukoplakia. * **Histology of Bowen’s:** Shows "windblown appearance" (loss of polarity), full-thickness atypia, and dyskeratotic cells. * **Arsenic Exposure:** Chronic arsenic ingestion is a known risk factor for developing multiple lesions of Bowen disease on non-sun-exposed areas.

Q: Which of the following is NOT a premalignant condition?

Zinc deficiency. **Explanation:** The correct answer is **Zinc deficiency**. In dermatology, a premalignant condition is a state or lesion that has a significantly increased risk of progressing to invasive squamous cell carcinoma (SCC) or other skin malignancies. **1. Why Zinc Deficiency is the correct answer:** Zinc deficiency manifests clinically as **Acrodermatitis Enteropathica**. It is characterized by the triad of periorificial and acral dermatitis, alopecia, and diarrhea. While it causes significant morbidity and skin breakdown, it is a nutritional/metabolic disorder and does **not** carry a risk of malignant transformation. **2. Analysis of Incorrect Options:** * **Arsenic Poisoning:** Chronic arsenic exposure leads to "arsenical keratoses" (typically on palms and soles) and multiple Bowen’s disease lesions. It is a well-known precursor to invasive SCC and Basal Cell Carcinoma (BCC). * **Ultraviolet (UV) Radiation:** Chronic UV exposure (especially UVB) causes DNA damage and mutations in the p53 tumor suppressor gene. it leads to **Actinic Keratosis**, which is the most common premalignant lesion in light-skinned individuals. * **Bowen’s Disease:** This is defined as **Squamous Cell Carcinoma in-situ**. It involves the full thickness of the epidermis but has not yet breached the dermo-epidermal junction. If left untreated, roughly 3-5% of cases progress to invasive SCC. **Clinical Pearls for NEET-PG:** * **Other Premalignant Conditions:** Xeroderma Pigmentosum, Erythroplasia of Queyrat (Bowen’s of the glans penis), Leukoplakia, and PUVA therapy. * **Acrodermatitis Enteropathica:** Look for the "vesiculobullous and eczematous" lesions around the mouth, anus, and eyes in infants. * **High-Yield Association:** Arsenic exposure is also associated with internal malignancies (lung, bladder, and liver angiosarcoma).

Q: Basal cell carcinoma commonly spreads by?

Direct spread. **Explanation:** **Basal Cell Carcinoma (BCC)** is the most common skin cancer globally. It arises from the non-keratinizing cells of the basal layer of the epidermis. 1. **Why Direct Spread is Correct:** BCC is characterized by **slow, progressive local invasion**. It spreads by infiltrating surrounding tissues (skin, subcutaneous fat, muscle, and even bone) through "finger-like" projections. This destructive local behavior is why it is colloquially termed a **"Rodent Ulcer"**—it appears as if a rodent has gnawed through the tissue. 2. **Why Other Options are Incorrect:** * **Lymphatic and Haematogenous Spread:** These are extremely rare in BCC (occurring in <0.1% of cases). BCC lacks the inherent biological aggressiveness to easily penetrate vessel walls or survive in the circulation. If metastasis does occur, it usually involves very large, neglected tumors or specific aggressive subtypes, but it is never the "common" mode of spread. * **All the above:** Since distant metastasis is an exception rather than the rule, this option is incorrect. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** Face, specifically above the line joining the lobe of the ear to the angle of the mouth (inner canthus and nose are frequent sites). * **Risk Factor:** Chronic UV light exposure is the primary trigger. * **Clinical Hallmark:** A pearly, translucent papule with telangiectasia and rolled-out borders. * **Histopathology:** Shows **Peripheral Palisading** (nuclei at the edge of tumor nests align vertically) and **Retraction Artifacts**. * **Prognosis:** Excellent, as it rarely metastasizes, though it can cause significant local morbidity if left untreated.

Question 1

An 8-year-old girl presents with numerous hypopigmented, ulcerated, and crusted patches on her face and forearms, as well as an indurated, crater-like skin nodule on the back of her left hand. Biopsy of this skin nodule reveals a squamous cell carcinoma. Molecular biology studies show that this patient has germline mutations in the gene encoding a nucleotide excision repair enzyme. What is the most likely diagnosis?

Accepted Answer

Xeroderma pigmentosum

Answer

Ataxia telangiectasia

Answer

Hereditary albinism

Answer

Li-Fraumeni syndrome

Question 2

A 50-year-old construction worker with a history of tobacco use for 20 years presents with a growth on his lower lip. Biopsy confirms a carcinoma. What is the most likely cancer?

Accepted Answer

Squamous cell carcinoma

Answer

Basal cell carcinoma

Answer

Malignant melanoma

Answer

Verrucous carcinoma

Question 3

Buschke-Löwenstein tumor is associated with which of the following?

Accepted Answer

Malignant transformation in an anogenital wart

Answer

Malignant transformation in a plantar wart

Answer

Malignant transformation in a common wart

Answer

Malignant transformation in a seborrheic wart

Question 4

Papillomatous tongue is observed in which of the following conditions?

Accepted Answer

Lymphangioma

Answer

Systemic hyalinosis (Alport syndrome with diffuse leiomyomatosis)

Answer

Foetal face syndrome

Answer

Tuberous sclerosis

Question 5

Bowen's disease is:

Accepted Answer

An intraepithelial carcinoma

Answer

A benign neoplasm of the G.I.T

Answer

A vesiculobullous lesion of the skin

Answer

An ulcerative lesion of the G.I.T

Question 6

An HIV-positive patient presents with a characteristic appearance of the leg and a history of HHV-8 infection. What is the most likely diagnosis?

Accepted Answer

Kaposi sarcoma

Answer

Lymphoma

Answer

Malignant melanoma

Answer

Non-Hodgkin's lymphoma

Question 7

Which of the following is a precancerous condition of the skin?

Accepted Answer

Bowen disease

Answer

Seborrhoeic keratosis

Answer

Leprosy

Answer

Psoriasis

Question 8

Which of the following is NOT a premalignant condition?

Accepted Answer

Zinc deficiency

Answer

Arsenic poisoning

Answer

Ultraviolet radiation exposure

Answer

Bowen's disease

Question 9

Which of the following statements about squamous cell carcinoma are true?

Accepted Answer

It is the most common skin tumor seen in transplant patients.

Answer

It is a commoner malignant skin tumor than basal cell carcinoma.

Answer

It occurs only in the skin.

Answer

Metastasis is usually to the regional lymph nodes.

Question 10

Basal cell carcinoma commonly spreads by?

Accepted Answer

Direct spread

Answer

Lymphatics

Answer

Haematogenous

Answer

All the above

Skin Tumors — MCQs

Skin Tumors — MCQs

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