An 83-year-old man comes to his physician for a routine check of his health status. On physical examination he has multiple 0.3 to 1.4 cm coin-like, lightly pigmented, velvety-surfaced lesions on his face and upper chest. These lesions have been present for many years and slowly enlarging. They are not painful and do not bleed when rubbed. Which of the following is the most likely diagnosis for this man's skin lesions?
A Actinic keratoses
B Basal cell carcinomas
C Epidermal inclusion cysts
D Impetigo
E Intradermal nevi
F Seborrheic keratoses
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A 39-year-old man has become concerned regarding a skin lesion on his chest which has recently become darker with irregular borders present. This lesion has enlarged from 1 cm to 1.5 cm over the past three months. On physical examination he has a slightly raised, irregularly pigmented brown to black lesion on the skin of his right upper chest. Which of the following is the most likely diagnosis?
A Lentigo nevus
B Malignant melanoma
C Intradermal nevus
D Hemangioma
E Basal cell carcinoma
F Squamous cell carcinoma
A 65-year-old man has been undergoing chemotherapy for treatment of a small cell anaplastic carcinoma of the right lung. He has been bothered for 3 weeks by an outbreak of pruritic lesions in a 2 x 14 cm area along the right trunk. On physical examination these skin lesions are 0.1 to 0.3 cm clear vesicles, some of which have been excoriated, ruptured, and become secondarily infected. Which of the following is the most likely diagnosis?
A Kaposi sarcoma
B Herpes zoster
C Neurofibromatosis
D Acne
E Impetigo
A 55-year-old diving instructor from Cancun, Mexico, has noted the appearance and growth of skin lesions for the past 4 years. On physical examination he has 10 lesions fron 0.5 to 1 cm in size. They are rounded, flat, tan-brown to slightly erythematous lesions with a rough, sandpaper-like consistency on the face, arms, and dorsa of both hands. Which of the following is the most likely diagnosis?
A Actinic keratosis
B Impetigo
C Junctional nevus
D Keratoacanthoma
E Seborrheic keratosis
A 38-year-old woman comes to her physician for a routine check of her health status. On physical examination she has a 1.2 cm irregular, darkly pigmented "mole" on the skin of her upper back. Excisional biopsy of the lesion is performed. Microscopic examination shows a malignant melanoma that is 2 mm in thickness, with margins clear. Which of the following statements is most appropriate regarding this woman's skin lesion?
A She will not have to worry further about this lesion
B The lesion has occurred in a non sun-exposed area
C There is a genetic basis for the occurrence of this lesion
D Human papillomavirus infection was present
E There may be metastases within 5 years
A 72-year-old man has noted a slowly enlarging nodule on his lower eyelid for the past 3 years. On physical examination this lesion is a 0.7 cm firm mass with a pearly appearance and central umbilication. The lesion is excised, the margins of the excision are clear, and it does not recur. Which of the following is the most likely diagnosis?
A Basal cell carcinoma
B Dermatofibroma
C Keratoacanthoma
D Melanoma
E Neurofibroma
F Sebaceous carcinoma
A 5-year-old girl is kept indoors during the day on the advice of the family physician, who has determined that there is a family history of skin cancers which occur at a young age. Microscopically, these are squamous cell carcinomas. Which of the following mechanisms best explains why this child is at risk with sun exposure?
A Balanced chromosomal translocation
B RB-1 mutation
C ERBB2 amplification
D Defective DNA repair
E K-RAS activation
Queensland, Australia has a very sunny climate and is populated by people of mostly northern European ancestry. The incidence of skin cancer in this population is high, compared to the native Aboriginal population. One health policy sponsored by the state government is aimed at getting people to wear which of the following items?
A Shoes
B Eyeglasses
C Hats
D Condoms
E Swimsuits
A 55-year-old man with a history of poorly controlled diabetes mellitus has developed painful enlargement of his leg during the past 6 days. On physical examination he has a 10 x 20 cm area of warmth and tenderness with swelling in the soft tissues of the left upper anterior thigh. A fasciotomy is performed and microscopic examination of tissue debrided shows necrotizing fasciitis. Which of the following risk factors is most likely to precede the onset of this condition?
A Disseminated Mycobacterium tuberculosis
B Diffuse scleroderma
C Viral infection
D Atherosclerosis
E Penetrating trauma
A 26-year-old man has noted pain in the region of his buttocks for the past 3 weeks. The pain occurs when he sits down for any length of time. Physical examination reveals some small pitted areas in the skin at the coccygeal region above the anal cleft, beneath which is a palpable 1 cm tender, soft, fluctuant mass. Which of the following is the most likely diagnosis?
A Pilonidal sinus and abscess
B Carbuncle
C Decubitus ulcer
D Adnexal skin tumor
E Bone spur
A 44-year-old woman is concerned about the change in colour with recent increase in size of a pigmented lesion on her left shoulder. On physical examination the 1.3 cm diameter, brownish-black, nodular lesion has irregular borders. This lesion is completely excised. Microscopically, the lesion is composed of large, pleomorphic cells with enlarged nuclei that have prominent large nucleoli. The scant cytoplasm of these cells contains a fine black pigment. Which of the following parameters is most important in determination of the prognosis for this patient?
A Her age
B Diameter of the lesion
C Length of sun exposure
D Location on the skin
E Depth of the lesion
A clinical study is performed of male subjects from 15 to 50 years of age who had superficial skin infections. One group of these subjects had erythematous, scaling patches from which skin scaping specimens were obtained. It was observed that fungal elements typical for Trichophyton rubrum were present. Which of the following did this group of patients most likely have?
A Impetigo
B Cold sore
C Vitiligo
D Ringworm
E Jock itch
A 43-year-old Caucasian man is noted to have 149 macular to slightly raised skin lesions, predominantly on the trunk and upper extremities. They range in size from 0.6 to 5 cm and are round to oval. Some have slightly irregular borders. They are pale brown to dark brown in colour. There is a family history of skin cancer. Which of the following is the most likely diagnosis?
A Blue nevi
B Junctional nevi
C Dysplastic nevus syndrome
D Cafe-au-lait spots
E Arsenic poisoning
A 46-year-old plumber comes to his physician because of a persistent skin lesion that has not healed in the past 3 months. On physical examination there is a 2 cm circumscribed necrotic ulcer on his right arm. Topical corticosteroid cream and antibiotics have no effect on the lesion. It is excised. Which of the following is the most likely diagnosis?
A Scabies
B Herpes simplex virus infection
C Candida albicans infection
D Basal cell carcinoma
E Brown recluse spider bite
A 51-year-old man from the Everglades of Florida who has lived by himself for many years finally came to a physician after losing the vision in his right eye. On physical examination there is a large fungating, infiltrative mass on his face that extends across the right orbital region and the bridge of the nose to impinge upon the epicanthal fold on the left. Which of the following is the most likely diagnosis?
A Malignant melanoma
B Basal cell carcinoma
E Kaposi sarcoma
A 19-year-old man comes to his physician because of a lesion on his hand that has been enlarging for the past 3 months. On physical examination there is a tan, flat, 1 cm rough-surfaced, non-tender papule on the dorsum of his left hand. Without therapy, this lesion recedes over the next 2 years. Which of the following is the most likely diagnosis?
A Herpetic dermatitis
B Syphilitic chancre
C Tinea versicolor
D Verruca vulgaris
F Scabies
A 29-year-old man is bothered by a "cold sore" on his upper lip. After a week, he notices the appearance of several rounded, slightly erythematous lesions on the palms of his hands averaging 0.4 to 0.8 cm in size. Each of the lesions has a targetoid appearance with a central dark red area. After a course of acyclovir, the lesions on his hands disappear. Which of the following conditions did he most likely have:
A Erythema multiforme
B Molluscum contagiosum
E Pemphigus vulgaris
Over the past 4 months a 25-year-old woman has noted the appearance of a skin rash on her face when she spends more than an hour in the sun. On physical examination there is an erythematous malar skin rash. Laboratory studies show a positive anti-nuclear antibody (ANA) test with a titer of 1:256 and anti-double stranded DNA titer of 1:256. A punch biopsy of non-sun exposed skin is performed. Immunofluorescence staining on this normal skin reveals band-like deposition of IgG and C3 at the dermal-epidermal junction. Which of the following immunologic disorders is she most likely to have?
A Polymyositis-dermatomyositis
B Discoid lupus erythematosus (DLE)
C Progressive systemic sclerosis (PSS)
D Systemic lupus erythematosus (SLE)
E Graft versus host disease (GVHD)
F Cutaneous vasculitis
A clinical study is performed with Caucasian subjects between 15 and 40 years of age who have at least one "mole" on their skin which was excised. The microscopic appearances of these lesions are analyzed. Most of these lesions are diagnosed as nevi, and most have varying shades of brown pigmentation. It is observed that these nevi evolve from junctional to compound to intradermal lesions with increasing age of the patient. The nevus cells appear similar to melanocytes by immunohistochemical staining pattern. Which of the following outcomes is most likely to occur in patients with these nevi?
A They become blue nevi
B They remain the same
C Malignant melanoma arises in them
D Actinic keratoses arise elsewhere
E They disappear
F They lose their pigmentation
A 56-year-old man with amyotrophic lateral sclerosis has been bedridden for the past year. He is found to have a 2 cm diameter area of skin ulceration extending to underlying soft tissue over the sacral region. Which of the following is the most likely diagnosis?
A Decubitus ulcer
B Superficial candida infection
C Basal cell carcinoma
D Tinea corporis infection
E Herpes zoster infection
F Pilonidal sinus
A 17-year-old girl has the onset of "hives" over the past 3 hours. On physical examination there are irregular, slightly raised, erythematous patches from 1 to 6 cm in size over all surfaces of her body. The lesions are pruritic. The lesions gradually fade over the next day without therapy. Which of the following is the most likely diagnosis?
A Type I hypersensitivity to oysters
B Discoid lupus erythematosus
C Contact dermatitis to poison ivy
D Psoriasis
E Progressive systemic sclerosis
A 29-year-old man incurs a burn injury to his lower leg when boiling water is spilled from a pot on the stove. On physical examination there is marked erythema over a 10 x 15 cm area on the anterior left thigh. A dressing is placed over this area. A week later there is sloughing of the skin. Regeneration of this burned area without the necessity for skin grafting occurs over the next month. Which of the following structures is most likely the source for proliferating cells to re-epithelialize the surface?
A Elastic fibers
B Fibroblasts
C Langerhans cells
D Macrophages
E Meissner corpuscles
F Melanocytes
G Sweat gland ducts
A 55-year-old man comes to his physician because of a rapidly enlarging nodule on his face. On physical examination there is a 1 cm diameter dome-shaped, flesh-colored nodule on his right cheek. While waiting 3 months for a referral to a dermatologist in his managed care health plan, the lesion disappears. Which of the following is the most likely diagnosis?
A Skin tag
B Keratoacanthoma
C Dermatofibroma
D Epidermal inclusion cyst
E Hemangioma
An epidemiologic study is performed to determine etiologies for skin cancer. It is observed that, in the last half of the 20th century, the incidence of skin cancers, including basal cell carcinomas, squamous cell carcinomas, and malignant melanomas, increased. This increase was most marked in Europe, North America, and Australia. Exposure to which of the following is most likely to be shown to have a statistically significant relationship to the increase in skin cancers?
A Chlorofluorocarbons (CFC's)
B Gamma radiation
C Nitrous oxides (NOx)
D Ozone (O3)
E Para-aminobenzoic acid (PABA)
F Television
G Ultraviolet B (UVB) radiation
An 87-year-old woman has developed painful skin lesions on her trunk over the past year. On physical examination there are 0.1 to 0.4 cm grouped vesicles in a dermatomal distribution on the skin of her left chest wall. The lesions do not respond to corticcosteroid or antibiotic therapy. The appearance of these lesions is most likely to be related to which of the following mechanisms?
A Bacterial infection
B Hyperglycemia
C Food allergy
D Immunodeficiency
E Prior sun exposure
A 26-year-old woman has noted a slowly enlarging genital lesion for the past 3 months. On physical examination she has a 1.2 cm diameter soft, tan to white lesion with a cauliflower-like appearance on the left labia of the vulva. Which of the following is most likely to have contributed to the development of this lesion?
A Human papillomavirus infection
B Blood transfusion
C Familial hypercholesterolemia
D Sunbathing
E Treponema pallidum infection
F Autoimmunity
Three children with ages from 5 to 10 in a family are all affected by itching lesions on their hands for the past 2 weeks. On physical examination there are erythematous areas with superficial excoriation on the fingers and dorsa of the hands. These areas are linear to ovoid. Application of lindane-containing cream results in resolution of the lesions within a week. Infection with which of the following did these children most likely have?
A Actinomyces israeli israeli
B Candida albicans
C Papovavirus
D Sarcoptes scabiei
E Staphylococcus aureus
F Trichophyton rubrum
A 39-year-old man with a previous diagnosis of cytomegalovirus (CMV) retinitis has noted the appearance of several reddish-purple plaques on his face and right hand over the past 7 months. A punch biopsy of one lesion is performed and on microscopic examination reveals normal appearing epidermis with a dermal proliferation of atypical spindle cells lining slit-like vascular spaces with extravasated red blood cells. Which of the following is the most likely diagnosis?
A CMV infection
B Keratoacanthomas
C Kaposi sarcoma
E Tinea versicolor
A 12-year-old boy has had the appearance of a skin lesion on his trunk for the past week. On physical examination there is a 2 x 3 cm ovoid erythematous slightly raised lesion on his left upper chest. The lesion exhibits central clearing to leave a serpiginous border. A scraping of the lesion is performed and microscopically there are fungal elements present consistent with Trichophyton rubrum. What common term is most often used to describe these lesions?
A "Wart"
B "Ringworm"
C "Crabs"
D "Sebaceous cyst"
E "Mole"
F "Shingles"
G "Zit"
A 39-year-old man has noted the appearance of scaling patches on his elbows, knees, and scalp over the past 6 months. On physical examination these lesions are 1 to 4 cm in diameter with a salmon pink to silvery gray appearance. He has yellow-brown discoloration with thickening and pitting of his fingernails. A punch biopsy of one lesion is performed and on microscopic examination shows thinning of the stratum granulosum, downward projection of the rete pegs, small neutrophilic aggregates in the superficial epidermis, and marked overlying parakeratosis. Therapy with methotrexate and UVA light reduces the size of the lesions. Which of the following is the most likely diagnosis?
A Bullous pemphigoid
B Dermatitis herpetiformis
C Erythema multiforme
D Lichen planus
F Psoriasis
A 5-year-old boy is brought to the pediatrician because he has developed facial skin lesions over the past 4 days. On examination there are multiple small 0.3 to 0.8 cm diameter pustules covered by a honey-colored crust on his upper neck, cheeks, and forehead. The crusts are removed and the lesions heal over the next week. Which of the following infectious agents is most likely responsible for development of this boy's skin lesions?.
A Herpes simplex virus
B Human papillomavirus
C Molluscum contagiosum
D Mycobacterium leprae
E Sarcoptes scabiei
F Staphylococcus aureus
G Trichophyton rubrum
In the 3 months following a traumatic laceration to the right upper chest, a 36-year-old African-American man notes the development of disfiguring nodular scarring in the region of the healed laceration. On examination there is a 1 x 4 cm subcutaneous area with an irregular firm, nodular appearance. Scar revision with excision of the lesion is performed. Which of the following microscopic appearances is this excised tissue most likely to show?
A Necrotizing acute inflammation
B Granulomas with caseous necrosis
C Apoptosis
D Dense collagen bundles
E Atypical squamous epithelium
A study is performed with subjects who worked at least 10 years as a lifeguard on a public beach. The control group consists of subjects who worked for the same amount of time in mushroom farms. The medical histories of these subjects are reviewed and the number and type of skin lesions analyzed. Which of the following neoplasms is most likely to be as frequent in the control group as in the study group?
B Squamous cell carcinoma
C Melanoma
A 10-year-old child complains of intense itching of his hands. Physical examination reveals several linear gray-brown lesions from 2 to 6 millimeters in length that appear in the skin between his fingers. Some of these lesions have been excoriated by scratching. Which of the following infectious agents is most likely to produce this boy's skin lesions?
A Papillomavirus
B Herpes zoster virus
C Sarcoptes scabiei
D Staphylococcus aureus
E Tinea corporis
A 25-year-old man has multiple firm nodules, some of which are up to 3 centimeters in size, that are disfiguring because they are located on his hands and arms. Also noted on physical examination are scattered light brown macules with smooth borders, averaging about 2 to 3 centimeters in size, over the skin of his trunk and arms. Which of the following conditions is he most likely to have?
A Neurofibromatosis
B Kaposi sarcoma
C Nevi
D Actinic keratoses
A 33-year-old man notes that there is a skin nodule in front of his right armpit which rubs on clothing and becomes irritated. This nodule has been slowly enlarging for the past 3 years. On physical examiantion, there is a 0.2 x 0.7 cm nodule covered with loose, wrinkled skin and attached to the skin at the right anterior axillary line by a narrow pedicle. The lesion is easily excised and on microscopic examination has a core of loose connective tissue covered by slightly hyperkeratotic epidermis. Which of the following is the most likely diagnosis?
A Dermatofibroma
B Fibroepithelial polyp
D Nodular fasciitis
A 16-year-old girl is bothered by a skin lesion on her face. She cannot remember when it first appeared, but she doesn't like it anymore. Her mother states that the lesion has not changed since early childhood. On physical examiantion there is a 0.7 cm diameter dome-shaped red nodule on her right cheek just lateral to her nose. It is smooth, firm, and non-tender. Which of the following is the most likely diagnosis?
A Basal cell epithelioma
C Fibroepithelial polyp
E Nevocellular nevus
A 53-year-old man has noted a "bump" at his belt line for the past year. He squeezed it a month ago and it subsequently enlarged and has remained tender. On physical examination there is a 2 cm subcutaneous nodule just above the right anterior iliac crest. This lesion is well-circumscribed and movable. It is excised and on sectioning is composed of a dermal keratin-filled cavity lined by squamous epithelium. Which of the following is the most likely diagnosis?
B Dermatofibrosarcoma protuberans
C Epidermal inclusion cyst
A 9-year-old girl has developed a skin rash over the past 2 days. On physical examination there are vesicular lesions from 1 to 5 cm in diameter on her extremities and trunk. There are 2 lesions on her buccal mucosa. These lesions have a central red nodule surrounded by a zone of erythema. This child was given antibiotic therapy for a otitis media one week ago. What is the most likely diagnosis?
A Dysplastic nevus syndrome
B Icthyosis
C Letterer-Siwe disease
D Mycosis fungoides
E Stevens-Johnson syndrome
F Xeroderma pigmentosa
A 74-year-old woman has noted an increasing size and number of pigmented lesions on her hands over the past 10 years. The lesions are non-pruritic. On physical examination she has multiple 0.3 to 1.5 cm pale brown macules with irregular borders on the dorsa of her hands. Which of the following is the most likely diagnosis?
A Compound nevi
B Dysplastic nevi
C Freckles
D Melasma
E Senile lentigenes
F Tinea versicolor
G Vitiligo
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