33 year old male printer complained of a 3 month history of hand dermatitis. Patch testing was negative. A biopsy showed spongiosis and lymphocyte exocytosis. No Munro’s microabcesses are seen.
Identify the most likely diagnosis.
• A. Prebullous pemiphigoid
• B. Psoriasis vulgaris
• C. Irritant/contact eczematous dermatitis
• D. Mycosis fungoides
• E. Drug reaction
• Which statement is false.
• Psoriasis:
a. Can result in alopecia
b. Sacrum affected
c. Pustular form exists
d. Histologically shows spongiform pustule of Kogoj
e. Vascular ectasia is seen with margination of neutrophils
• A 34 year old patient presents with multiple silvery skin plaques. A skin biopsy is performed to confirm the diagnosis.
• Identify the finding which would not be consistent with a diagnosis of psoriasis.
a. Can result in alopecia
b. Sacrum affected
c. Pustular form exists
d. Histologically shows spongiform pustule of Kogoj
e. Vascular ectasia is seen with margination of neutrophils
• A 34 year old patient presents with multiple silvery skin plaques involving the extensor surface of the limbs, scalp and lower back. The condition is worse after periods of stress and localises to areas of trauma. A skin biopsy is performed to confirm the diagnosis.
• Identify the finding which would not be expected in this condition.
a. Can result in alopecia
b. Sacrum affected
c. Pustular form exists
d. Histologically shows spongiform pustule of Kogoj
e. Vascular ectasia is seen with margination of neutrophils
• A 34 year old patient presents with multiple silvery skin plaques involving the extensor surface of the limbs, scalp and lower back. The condition is worse after periods of stress and localises to areas of trauma. A skin biopsy is performed to confirm the diagnosis.
• Identify the finding which would not be expected in this condition.
a. Fibrous replacement of hair follicles
b. Parakeratosis
c. Neutrophilic pustules in the epidermis
d. Vascular ectasia is seen with margination of neutrophils
e. Loss of the granular cell layer
• A 44 year old taxi-driver presents with an sudden eruption on the trunk and limbs. Target lesions are present on the hands and feet. His skin biopsy shows basal cell damage with apoptotic keratinocytes.
• Identify the most likely diagnosis.
a. Lichen planus
b. Dermatomyositis
c. Erythema multiforme
d. Chronic graft versus host disease
e. Lichen nitidus
• Which of the following conditions does not show a leukocytoclastic vasculitis?
A. Erythema nodosum
B. Microscopic polyangiitis
C. Wegeners granulomatosis
D. Polyarteritis nodosa
E. Urticarial vasculitis
• A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised. A skin biopsy is taken and shows features of a leukocytoclastic vasculitis.
• Identify the condition which does not show this feature.
A. Erythema nodosum
B. Eosinophilic granulomatosis with polyangiitis
C. Granulomatosis with polyangiitis
D. Polyarteritis nodosa
E. Urticarial vasculitis
• A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised. A skin biopsy is taken and shows fibrinoid necrosis of vessel walls with leukocytoclasis and red blood cell extravasation.
• Identify the condition which would not show these features.
A. Erythema nodosum
B. Eosinophilic granulomatosis with polyangiitis
C. Granulomatosis with polyangiitis
D. Polyarteritis nodosa
E. Urticarial vasculitis
• A 42 year old patient presents with purpuric lesions involving both limbs. Inflammatory markers are raised. A skin biopsy is taken and shows fibrinoid necrosis of vessel walls with leukocytoclasis and red blood cell extravasation.
• Identify the most likely diagnosis.
A. Erythema nodosum
B. Eczematous dermatitis
C. Epidermolysis bullosa acquista
D. Erythema multiforme
E. Polyarteritis nodosa
• Which of the following conditions is not associated with granulomatous inflammation.
A. Sarcoidosis
B. Granuloma annulare
C. Pemphigus vulgaris
D. Fungal infection
E. Tuberculosis
• A 58 year year old woman presents with itchy annular skin lesions. She has a history of Crohn’s disease for which she is on systemic therapy. A skin biopsy show aggregates of histiocytes. A Grocott silver stain is positive.
• Identify the most likely diagnosis.
A. Sarcoidosis
B. Granuloma annulare
C. Necrobiosis lipoidica
D. Fungal infection
E. Metastatic Crohn’s disease
• A 59 year old lady presents with annular lesions over the dorsal surfaces of both hands. A biopsy shows an interstitial infiltrate of histiocytes with mucin deposition and focal necrobioisis. No plasma cells are seen.
• Identify the most likely diagnosis
• Necrobiosis lipoidica
• Sarcoidosis
• Granuloma annulare
• Fungal infection
• Rheumatoid nodules
• A 68 year old female has a 1/52 history of tense large blisters arising on erythematous skin. A skin biopsy shows a subepidermal blister containing eosinophils.
• Identify the most likely diagnosis.
A.Pemphigus vulgaris
B.Pemphigus foliaceus
C.Darier’s disease
D.Bullous pemphigoid
E.Grover’s disease
• Predisposing factors for squamous cell carcinoma are all the following except:
a. UVB exposure
b. HPV Infection
c. Immunosuppression
d. Scarring
e. HHV-8 Infection
• A 35 year old presents with an invasive poorly differentiated squamous cell carcinoma of the scalp.
• Identify the most likely aetiological factor.
a. Solar damage/sun exposure
b. Immunosuppression
c. HHV8 infection
d. Previous radiotherapy
e. Idiopathic
• A 72 year old presents with a squamous cell carcinoma of the scalp. An excision biopsy is performed and reported as per the RCPath dataset.
• Identify which feature would upstage the tumour to pT3.
A- Perineural invasion –subcutis nerves
B- Location in head and neck
C- Depth of invasion 5.5mm
D- Clinical diameter >20mm
E- Lymphovascular invasion
• A 72 year old presents with an ulcerating tumour of the scalp. He has had androgenetic alopecia for many years. A biopsy shows basaloid nests of atypical cells infiltrating the dermis.
• Identify the most likely predisposing factor in this case.
a. Solar damage
b. Immunosuppression
c. Gorlins syndrome
d. Xeroderma pigmentosum
e. Underlying lichen planopilaris
• All the following lesions are benign except
• A 27 year old man presents with a pigmented lesion on the upper arm. An excision biopsy is performed. The lesion is compound in nature with prominent Pagetoid ascent in the epidermis and multiple dermal mitoses (3 per mm2).
• Identify the most important prognostic factor.
a. Depth of invasion
b. Macroscopic diameter
c. Presence of dermal mitoses
d. Pagetoid ascent
e. Absence of tumour infiltrating lymphocytes
• A 23 year old woman presents with a changing melanocytic lesion on the sole of the foot. An excision biopsy shows malignant melanoma.
• Identify the most likely genetic mutation.
a. cKIT
b. BRAF
c. ALK
d. k-RAS
e. Tyrosine kinase
Options
A.Trichoepithelioma
B.Basal cell carcinoma
C.Halo naevus
D.Compound melanocytic naevus
E. Intradermal melanocytic naevus
F. Blue naevus
G.Keratoacanthoma
H.Lichen planus
I. Malignant melanoma
J. Trichilemmoma
K.Seborrhoeic keratosis
L. Simple lentigo
M.Squamous cell carcinoma
Question 1 A 55 year old female present with a pigmented lesion on the hand. Histology shows naevus cells in the dermis with pigmented dendritic processes with overlying normal epidermis.
• Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.
Options
A.Trichoepithelioma
B.Basal cell carcinoma
C.Halo naevus
D.Compound melanocytic naevus
E. Intradermal melanocytic naevus
F. Blue naevus
G.Keratoacanthoma
H.Lichen planus
I. Malignant melanoma
J. Trichilemmoma
K.Seborrhoeic keratosis
L. Simple lentigo
M.Squamous cell carcinoma
Question 2
A 35 year old man present with a pigmented lesion on the arm with an outer hypo-pigmented area. Biopsy shows a band of inflammatory cells at the dermo-epidermal junction with scattered bland nests of naevus cells.
• Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.
Options
A.Trichoepithelioma
B.Basal cell carcinoma
C.Halo naevus
D.Compound melanocytic naevus
E. Intradermal melanocytic naevus
F. Blue naevus
G.Keratoacanthoma
H.Lichen planus
I. Malignant melanoma
J. Trichilemmoma
K.Seborrhoeic keratosis
L. Simple lentigo
M.Squamous cell carcinoma
Question 3
A 28 year old female with a papule on the nose. Histology shows islands of basaloid cells with occasional mitotic activity and papillary mesenchymal bodies.
• Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.
Options
A.Trichoepithelioma
B.Basal cell carcinoma
C.Halo naevus
D.Compound melanocytic naevus
E. Intradermal melanocytic naevus
F. Blue naevus
G.Keratoacanthoma
H.Lichen planus
I. Malignant melanoma
J. Trichillemmoma
K.Seborrhoeic keratosis
L. Simple lentigo
M.Squamous cell carcinoma
Question 4
A 70 year old man presents with a ulcerated lesion on the face. Skin biopsy shows squamous islands in the dermis with atypia and dyskeratosis.
• Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.
Options
A.Trichoepithelioma
B.Basal cell carcinoma
C.Halo naevus
D.Compound melanocytic naevus
E. Intradermal melanocytic naevus
F. Blue naevus
G.Keratoacanthoma
H.Lichen planus
I. Malignant melanoma
J. Trichilemmoma
K.Seborrhoeic keratosis
L. Simple lentigo
M.Squamous cell carcinoma
Question 5
A 68 year old man with multiple papules on the face. Histology shows epidermal proliferation with glycogenated keratinocytes, peripheral palisade and thickened basement membrane. No atypia or mitoses are seen.
• Each of these subjects has a skin biopsy. For each one, select the most likely condition form the list of options. Each may be use once, more than once, or not at all.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.ROS1
L. ALK
M.PRAME
An intradermal melanocytic lesion show spindle cell morphology with fibrillary cytoplasm. A diagnosis of deep penetrating melanocytoma is suspected on H&E sections.
Identify the IHC stain which would be most helpful in confirming this diagnosis.
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion.
Identify the more relevant option based on the descriptions above.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.PRAME
A 9 year old child presents with a compound melanocytic lesion demonstrating epithelioid morphology and prominent Kamino bodies. Identify the IHC stain which would be most helpful in confirming this is a Spitzoid lesion.
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion. Identify the more relevant option based on the descriptions above.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.PRAME
Question 3
A 52 year old patient is diagnosed with malignant melanoma. Complete loss of which IHC stain suggests homozygous deletion of CDKN2a?
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion. Identify the more relevant option based on the descriptions above.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.PRAME
A 72 year old patient presents with an ill defined junctional melanocytic lesion on their face and is diagnosis with lentigo maligna. IHC is performed and one of the markers show strong and diffuse nuclear positive staining throughout the lesion, helping to confirm the diagnosis. Identify the most likely answer.
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion. Identify the more relevant option based on the descriptions above.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.PRAME
Question 5
A 31 year old patient is diagnosed with stage pT4b invasive malignant melanoma. Which IHC stain should be performed to guide further management.
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion. Identify the more relevant option based on the descriptions above.
Options
A.MelanA
B.SOX10
C.S100
D.HMB45
E. P16
F. BRAF V600E
G.BAP1
H.Ki67
I. Beta-catenin
J. NTRK
K.PRAME
A 25 year of patient presents with a melanocytic lesion on their arm. They have a FHx of thyroid and renal cancer and ocular melanoma. The lesion is compound and shows mixed naevoid and epithelioid morphology on H&E sections with an associated lymphocytic infiltrate. Identify the relevant IHC stain to confirm the specific diagnosis in this case.
• Each of these immunohistochemistry stains can be used in diagnosing melanocytic lesion. Identify the more relevant option based on the descriptions above.