Melanoma (Cutaneous) Quiz
Created by Chris Galbraith and Connor Bohlken
Edited by Dr. Paris Ingledew
You are a 3rd year medical student working with Dr. Cellular, a pathologist at your local hospital. You are looking at some slides of tissue taken from a patient who had a lesion that was suspicious for some form of skin malignancy. Dr. Cellular has identified the tissue as containing melanoma. As a teaching exercise he gets you to view the tissue with him under his teaching microscope. He moves the pointer to the primary cell type in the epidermis that melanoma develops from and asks you what it is. You answer:
You are working in the dermatology clinic and go see your next patient, Mrs. Molly. She is a 78 year old Asian female with a history of excessive tanning bed use. On further history, she endorses a liver transplant for cirrhosis, and the genetic condition xeroderma pigmentosum. On physical exam you notice a large number of nevi, and congenital dermal melanocytosis. Which of the following is NOT a risk factor for melanoma.
Post Liver Transplant
Large Number of Nevi
Congenital Dermal Melanocytosis
For melanoma, screening consists of a short physical examination to identify suspicious lesions that require further evaluation. In particular it is very important to screen high risk patients. Which of the following would be considered a high risk patient?
64 year old male, 7 atypical nevi.
72 year old female, 42 normal nevi.
58 year old female, blistering sunburn last year.
51 year old male, family history of melanoma.
You are a 3rd year medical student working in the Dermatology Clinic with Dr. Naykidbawhdy. You see your first patient together, Mr. Spottyback who is a 52 year old male referred to the clinic by his family doctor. He hadn’t been to a doctor in 5 years and when asked about the history he states: “Well, I figured it was finally time to get this thing on my back looked at Doc. It popped up about 3 years ago and seems to be slowly changing, it doesn't hurt or bleed too much”. Following acquisition of a biopsy and leaving the room. Dr. Naykidbawhdy asks: “So what is it?” This is what you saw:
Superficial Spreading Melanoma
You have just finished looking at a suspicious looking lesion which developed over the past couple of months on Mr. Neil Vi, a 72 year old sharply dressed gentleman. Luckily, for Mr. Vi this one turned out to be a seborrheic keratosis. Mr. Vi is reassured but wants to know more about what makes a skin lesion suspicious. You tell him about the ABCDE diagnostic aid. Which of the following is part of the ABCDE acronym?
Sun Damaged skin
Which of the following patient presentations is most representative of an acral lentiginous melanoma?
78 year old white female, freckle like tan brown macule on the neck.
68 year old black male, brown subungual unevenly pigmented patch.
72 year old white male, dome shaped, darkly pigmented and pedunculated nodule on the back.
58 year old white female, flat variably pigmented plaque with irregular border on the legs.
It’s your second day in clinic with Dr. Naykidbawhdy. Today you are seeing Ms. Bossenoire, a 74 year old woman. She is a frequent visitor to her family doctor clinic and was surprised one day when her family doctor recommended a skin exam prior to vacationing in Florida for 6 months this year. Fortunately, during the exam, the family doctor noticed a suspicious skin lesion on her back and opted to refer her urgently to your clinic. Dr. Naykidbawhdy looked at the lesion for about 3 seconds and seemed to have a high suspicion of what it is, after collecting a biopsy you leave the patient room and Dr. Naykidbawhdy asks what you suspect it is. This is what you saw:
Superficial Spreading Melanoma
You have just finished seeing a suspicious looking nevi, and are wondering if you should refer to dermatology. You are aware of the Revised Glasgow 7 Point Checklist, which consists of major features (2 points each) and minor criteria (1 point each). Any score greater than 3 suggests a referral. Which of the following is a major feature?
Diameter > 7mm
Change in Colour
Crusting or Bleeding
You’re a 4th year medical student on a Oncology elective with Dr. Cuttem, who primarily treats skin cancers. You start the day with a review of the staging of melanoma. Dr. Cuttem asks you, if you had a patient with melanoma with the following characteristics: Primary tumor 3.1 mm depth with no ulceration, involvement of 3 lymph nodes, one of which is clinically detectable, and no metastasis. What TNM stage would it be?
T3a, N2b, M0
T2b, N2a, M0
T2a, N2b, M0
You have just seen Mr. Mal Noma in the clinic. He is a 81 year old male with a recent diagnosis of superficial spreading melanoma. The melanoma was found to be localized, and has a tumor thickness of 0.9mm. Mr. Noma would like to pursue treatment, he asks you what the best treatment option is for him. You answer:
Which of the following patients each with a 1.3 cm Superficial spreading on their back has the worst prognosis?
Patient A, no nodes involved.
Patient B, 4.1 mm depth.
Patient C, female patient.
Patient D, non-ulcerated.
Patient E, diagnosed at age 49.
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