QUESTION: 109

A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder.

Which of the following is true of this patient's skin condition?

It is the most common malignancy in the United States.
Total body skin examination reduces the morbidity and mortality associated with this condition.
Metastasis is common.
The cure rate is approximately 50%.
If appropriately treated, the rate of recurrence (development of a second lesion) is equal to that found in the general population.

Answer(s): A

Explanation:

Nonmelanoma skin cancer is the most common cancer in the United States. Of this group of cancers, approximately 7080% are basal cell carcinomas (BCC). The majority of the remaining 2030% are squamous cell carcinomas (SCC). Metastasis is less common in BCC than SCC, with an estimated risk for metastasis of less than 0.1%. There is no evidence that total body skin examination reduces morbidity or mortality associated with BCC. The cure rate of BCC ranges anywhere from 80 to 99% depending on the treatment modality employed. Despite adequate treatment, individuals with a prior BCC lesion are at increased risk for development of a subsequent BCC (with a 40% risk of development 35 years after treatment).

The most important risk factor for development of BCC is exposure to UVB (or shortwavelength ultraviolet) radiation. There is some evidence, however, that UVA (or longwavelength ultraviolet) radiation also confers a risk. Sporadic, intense episodes of sun exposure, particularly during childhood, are associated with increased risk of BCC development later in life. Conversely, SCC is apparently associated with cumulative sun exposure, regardless of intensity. Other risk factors implicated in BCC development include arsenic exposure, immunosuppression, exposure to other forms of radiation, and the presence of other skin- affecting conditions such as xeroderma pigmentosum and basal cell nevus syndrome.

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QUESTION: 110

A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder.

Which of the following is the most important risk factor for development of this skin condition?

immunosuppression
presence of a chronic inflammatory skin condition
chronic arsenic exposure
exposure to long-wavelength ultraviolet radiation
exposure to short-wavelength ultraviolet radiation

Answer(s): E

Explanation:

Nonmelanoma skin cancer is the most common cancer in the United States. Of this group of cancers, approximately 7080% are basal cell carcinomas (BCC). The majority of the remaining 2030% are squamous cell carcinomas (SCC). Metastasis is less common in BCC than SCC, with an estimated risk for metastasis of less than 0.1%. There is no evidence that total body skin examination reduces morbidity or mortality associated with BCC. The cure rate of BCC ranges anywhere from 80 to 99% depending on the treatment modality employed. Despite adequate treatment, individuals with a prior BCC lesion are at increased risk for development of a subsequent BCC (with a 40% risk of development 35 years after treatment).
The most important risk factor for development of BCC is exposure to UVB (or shortwavelength ultraviolet) radiation. There is some evidence, however, that UVA (or longwavelength ultraviolet) radiation also confers a risk. Sporadic, intense episodes of sun exposure, particularly during childhood, are associated with increased risk of BCC development later in life. Conversely, SCC is apparently associated with cumulative sun exposure, regardless of intensity. Other risk factors implicated in BCC development include arsenic exposure, immunosuppression, exposure to other forms of radiation, and the presence of other skin- affecting conditions such as xeroderma pigmentosum and basal cell nevus syndrome.

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QUESTION: 111

A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder.
The treatment modality associated with the lowest recurrence rate is which of these?

radiation therapy
Mohs micrographic surgery
surgical excision
electrodesiccation with curettage
cryotherapy

Answer(s): B

Explanation:

Nonmelanoma skin cancer is the most common cancer in the United States. Of this group of cancers, approximately 7080% are basal cell carcinomas (BCC). The majority of the remaining 2030% are squamous cell carcinomas (SCC). Metastasis is less common in BCC than SCC, with an estimated risk for metastasis of less than 0.1%. There is no evidence that total body skin examination reduces morbidity or mortality associated with BCC. The cure rate of BCC ranges anywhere from 80 to 99% depending on the treatment modality employed. Despite adequate treatment, individuals with a prior BCC lesion are at increased risk for development of a subsequent BCC (with a 40% risk of development 35 years after treatment).

The most important risk factor for development of BCC is exposure to UVB (or shortwavelength ultraviolet) radiation. There is some evidence, however, that UVA (or longwavelength ultraviolet) radiation also confers a risk. Sporadic, intense episodes of sun exposure, particularly during childhood, are associated with increased risk of BCC development later in life. Conversely, SCC is apparently associated with cumulative sun exposure, regardless of intensity. Other risk factors implicated in BCC development include arsenic exposure, immunosuppression, exposure to other forms of radiation, and the presence of other skin- affecting conditions such as xeroderma pigmentosum and basal cell nevus syndrome.

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QUESTION: 112

An 18-year-old female presents for evaluation of facial acne. On examination, she has multiple comedones, papules, and pustules on her forehead, nose, cheeks, and chin. She also has several distinct nodules, each greater than 5 mm in diameter. Which of the following is most appropriate for initial inclusion in a regimen to treat this patient's acne?

erythromycin gel
tretinoin 0.025% cream
clindamycin lotion
oral tetracycline
oral isotretinoin

Answer(s): D

Explanation:

This patient has nodulocystic acne which is characterized by the presence of multiple comedones, inflammatory papules, pustules, and large nodules. Characteristically, the nodules measure greater than 5 mm in diameter. Initial therapy should include a systemic antibiotic such as tetracycline or erythromycin. Use of local therapy alone may be adequate in individuals with comedonal acne. In cases of acne which feature more of an inflammatory component (with papules and pustules), topical and oral antibiotics are useful. Oral isotretinoin is indicated for severe nodulocystic acne that is unresponsive to other therapies.

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QUESTION: 109

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QUESTION: 111

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