November Practice Questions

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All answers with explanations can be found at the end of the page!

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1. A 76-year-old man presents with a lesion on the right side of his nose which has been gradually getting bigger over the past 2-3 months. On examination you observe a round, raised, flesh coloured lesion which is 3mm in diameter and has a central depression. The edges of the lesion appear rolled and contain some telangiectasia.

What is the most likely diagnosis?

A. Squamous cell carcinoma

B. Malignant Melanoma

C. Basal Cell Carcinoma

D. Actinic Keratosis

E. Molluscum Contagiosum

2. A 32-year-old woman attends the clinic to get her mole checked after reading a newspaper article about skin cancers. She is worried about her lesion shown in the picture as it has been growing bigger over the past 3 months. She is uncertain how long it has been there. It does not bleed or itch.

What do you think is the likely diagnosis?

A. Basal cell carcinoma

B. Malignant Melanoma

C. Actinic keratosis

D. Compound naevus

E. Junctional naevus

3. A 78-year-old man presents with a lesion on his right cheek. This has slowly been getting larger over the past 6-7 months. He has no history of skin problems and the only past medical history of note is osteoarthritis of the knee and depression.

What is the likely diagnosis?

A. Squamous Cell Carcinoma

B. Keratoacanthoma

C. Basal Cell Carcinoma

D. Actinic keratosis

E. Amelanotic malignant melanoma

4. Charlie is a 78-year-old retired gardener. Although he is retired, he still enjoys tending to his own garden, particularly on warm, sunny days. As a result, he spends much of his time outside. He has recently noticed some scaly white and red patches on his forehead that he is concerned about. He has read online this this can be a precursor to skin cancer. Which skin cancer is the main concern in this case?

A. Basal Cell Carcinoma

B. Squamous Cell Carcinoma

C. Amelanotic malignant melanoma

D. Superficial malignant melanoma

E. Psoriasis

5. Which statement is true regarding the pathophysiology of melanoma?

A. Melanoma develops when keratinocytes mutate in the stratum germinativum

B. Melanoma of the skin originates from melanocytes found in the stratum basale

C. Melanoma only occurs on the skin and is the most aggressive type of skin cancer

D. Melanoma arises from the squamous cells in the stratum spinosum

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We hope you found these questions useful. For the answers, please refer below

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Answer 1: C

Explanation: Basal cell carcinoma (BCC) is one of the three main types of skin cancer. Lesions are also known as rodent ulcers and are characterised by slow-growth and local invasion. Metastases are extremely rare

The most common type of BCC is described here which is nodular BCC. Key characteristic findings from the question shows that the lesion occurs on a sun-exposed site, pearly, flesh-coloured papule with telangiectasia which may later ulcerate leaving a central 'crater'.

Answer 2: B

Explanation: Malignant melanoma is the tumour of melanocytes. This lesion has several features of malignancy- Asymmetry, Irregular border & surface feature &non-uniform colour. Diameter is likely to be more than 0.6cm Most worrying feature is that it is evolving.

Other options are wrong as actinic keratosis is a pre-malignant lesion caused by chronic sun exposure consisting of thick, scaly or crusty patches.

Basal cell carcinoma explained in previous question

Not junctional or compound naevus as they are just melanocytic naevi and present differently

Answer 3: A

Explanation: Appears as a firm pink lump with a rough or crusted surface. There can be a lot of surface scale and sometimes even a spiky horn sticking up from the surface. The lump often feels tender when touched, bleeds easily and may develop into an ulcer. With BCC's these are generally found on the rolled edges of the lesion rather than being scattered around the periphery.

Answer 4: B

Explanation: This description is suggestive of actinic keratosis, which is a precursor to SCC. BCCs do not have precursor lesions.

Answer 5: B

Explanation: This is the only correct statement about melanoma. It can occur anywhere in the body where there are melanocytes (example: middle layer of the eyes (uvea), epidermis etc.) and it originates from the melanocytes.

References:

Dermsoc Dundee Society MCQs

Skin cancer nclex questions [Internet]. 2019. Available from: https://www.registerednursern.com/skin-cancer-nclex-questions/