Skin Tumors & Oncology

A 62-year-old with a 7-mm pearly papule with telangiectasias on the nasal ala; dermoscopy shows arborizing vessels. Best management?

A 45-year-old has multiple thin erythematous scaly macules on the forehead and temples (“field cancerization”). Best therapy?

A 70-year-old with a 1.2-cm indurated, infiltrative plaque at the medial canthus; biopsy: morpheaform BCC. Best approach?

A 58-year-old smoker with a crusted ulcer on the lower lip vermilion; biopsy: well-differentiated SCC. Optimal management?

A 63-year-old with rough scaly papules on dorsal hands; many lesions. Most effective office procedure for isolated thicker AKs before field therapy?

A 68-year-old with a rapidly growing crateriform nodule with central keratin plug on forearm; biopsy suggests keratoacanthoma. Best next step?

A 74-year-old with a scaly erythematous plaque on shin; biopsy: SCC in situ (Bowen disease). Preferred treatment on distal leg?

A 56-year-old with melanoma 0.9 mm thick and ulcerated on upper back. Best next step?

A 48-year-old with melanoma 0.6 mm, non-ulcerated. Management?

A 72-year-old with lentigo maligna on cheek (melanoma in situ). Best surgical approach?

A 60-year-old with melanoma 2.2 mm on calf. Proper surgical margins?

A 41-year-old with melanoma 0.8 mm, non-ulcerated, mitotic rate low. What about SLNB?

A 39-year-old with a firm plaque on trunk; biopsy: storiform spindle cells, CD34+, factor XIIIa–, t(17;22). Diagnosis/management?

A 77-year-old with a rapidly growing, painless violaceous nodule on the temple; CK20 perinuclear dot pattern. Best initial plan?

A 45-year-old man with HIV (CD4 120) has violaceous plaques on legs and palate. First-line systemic step?

A 62-year-old with patch-stage mycosis fungoides (limited “bathing-trunk” patches). Best therapy?

A 70-year-old with erythroderma, generalized lymphadenopathy, and circulating cerebriform T cells. Diagnosis/initial therapy?

A 69-year-old with an ulcerated indurated plaque on ear helix; biopsy: poorly differentiated SCC with perineural invasion. Best approach?

A 66-year-old with a shiny papule; biopsy shows basosquamous carcinoma. Management?

A 58-year-old with a firm bluish papule on scalp; biopsy: atypical spindle/pleomorphic cells, actinic damage, negative cytokeratins/S100, diagnosis AFX. Best treatment?

A 72-year-old with chronic burn scar ulcer now shows SCC. Term/management?

A 54-year-old with longitudinal melanonychia (single band widening, pigment on periungual skin). Next step?

A 62-year-old with acral lentiginous melanoma on heel, 1.8 mm thick, non-ulcerated. Management?

An elderly man with desmoplastic melanoma of scalp, 3.0 mm, neurotropism present. Best local plan?

A 50-year-old with multiple early-onset BCCs, palmar pits, and odontogenic keratocysts. Counseling?

A 73-year-old with a pearly 8-mm papule on trunk confirmed as nodular BCC. Adequate standard excision margins?

A 61-year-old renal transplant recipient with multiple SCCs. Helpful chemoprevention?

A 68-year-old with extensive facial AK field and thin SCC in situ; desires minimal downtime. Best option?

A new 1.2-cm pink papule with rolled border and ulceration on shoulder; dermoscopy shows arborizing vessels. What immunostain supports diagnosis?

A 64-year-old with a firm ulcerated nodule on dorsal hand; biopsy: invasive SCC, depth 5 mm, perineural invasion. Best staging step?

A 55-year-old with metastatic cSCC not amenable to surgery/RT. Most appropriate systemic therapy?

A 69-year-old with locally advanced, unresectable BCC. Which targeted drug?

A 47-year-old with stage III melanoma post-lymphadenectomy asks about adjuvant therapy. Best option?

A 52-year-old with BRAF V600E metastatic melanoma, symptomatic visceral disease. First-line systemic approach?

A 81-year-old with purplish nodules in chronically lymphedematous arm post-mastectomy. Likely diagnosis/next step?

A 59-year-old with anogenital pruritic erythematous plaque; biopsy: Paget cells (CK7+, mucin+). Key workup?

A 40-year-old with dark, irregular macule on back; dermoscopy shows atypical network, streaks, multiple colors. Best next step?

A 67-year-old with a firm dermal nodule; biopsy: spindle-cell melanoma S100/SOX10+, desmoplastic features. Expected SLNB result compared to conventional melanoma?

A 76-year-old with scaly plaque on scalp; biopsy: actinic keratosis with focal bowenoid change. Counseling?

A 59-year-old with periauricular numbness and a cheek SCC treated 1 year ago now presents with recurrent pain. Concern?

A 71-year-old with a pearly papule on the medial canthus; biopsy confirms infiltrative BCC with perineural invasion. Best adjuvant step after Mohs with close but clear margins?

A 63-year-old with multiple thin AKs across the scalp wants a “field” option with short downtime. Best choice?

A 58-year-old with a 1.4-mm non-ulcerated melanoma on the upper back. Proper surgical margin?

A 67-year-old with a positive sentinel lymph node (micrometastasis) after melanoma excision. Current standard management?

A 46-year-old with ulcerated 0.9-mm melanoma (T1b). Plan regarding nodes?

A 75-year-old with tender violaceous papulonodules on chronically edematous arm post-lymph node dissection. Likely tumor and key stain?

A 52-year-old with erythematous plaque on scrotum; biopsy shows extramammary Paget disease. Most appropriate workup?

A 34-year-old with multiple early-onset BCCs and jaw cysts. Which counseling is essential?

A 60-year-old transplant recipient develops rapidly recurring SCCs. Evidence-based chemoprevention?

A 69-year-old with a 1-cm nodular BCC on the trunk. Adequate excision margin?

A 43-year-old with a pink pearly papule; biopsy favors BCC. Which immunostain supports BCC?

A 59-year-old with SCC of the lower lip, 1.5 cm, moderately differentiated. What regional evaluation is appropriate?

A 72-year-old with lentigo maligna on cheek prefers tissue-sparing therapy. Best surgical approach?

A 29-year-old runner has a 6-mm firm blue-black papule; dermoscopy shows homogenous steel-blue color without network. Likely lesion?

A 7-year-old with a rapidly growing pink papule on the cheek; dermoscopy shows starburst pattern; pathology favors Spitz tumor. Best next step?

A 66-year-old with 0.5-mm melanoma in situ on trunk. Proper margin?

A 48-year-old with nodular melanoma, BRAF V600E+, multiple lung mets and LDH elevated, symptomatic. Best initial systemic approach?

A 70-year-old with a firm, flesh-colored nodule on ear; biopsy: microcystic adnexal carcinoma. Key management feature?

A 61-year-old with multiple cutaneous horns on dorsal hands; one is tender at the base. Best approach?

A 44-year-old with solitary pink dome papule that dimples on lateral compression. Likely diagnosis and management?

A 53-year-old with a 1.1-cm SCC on dorsal hand, poorly differentiated, 7 mm deep. Surgical plan?

A 76-year-old with erythematous plaque on thigh; biopsy: MF patch stage. Best first-line?

A 65-year-old with hundreds of SKs and sudden onset of pruritus; also 10-pound weight loss. Name/significance?

A 55-year-old presents with solitary violaceous nodule; biopsy: Merkel cell carcinoma, CK20 dot+, TTF-1 negative. Next step?

A 68-year-old with brown-gray macule on vulva; histology shows melanosis without atypia. Management?

A 50-year-old on BRAF/MEK therapy develops multiple eruptive keratoacanthomas. Management?

A 40-year-old with DFSP unresectable by surgery. Targeted therapy option?

A 72-year-old with bleeding plaque on glans; biopsy: SCC in situ (erythroplasia of Queyrat). Preferred therapy?

A 61-year-old with crusted lower lip and actinic cheilitis refractory to topicals. Best definitive approach?

A 58-year-old with a 0.7-mm non-ulcerated melanoma on forearm asks about SLNB. Recommendation?

A 64-year-old with a slowly enlarging, firm, subcutaneous nodule; biopsy: pleomorphic dermal sarcoma (deeper AFX variant). Treatment?

A fair-skinned 9-year-old with freckling in sun-exposed areas, severe photosensitivity, and multiple early lentigines. Most likely condition/priority?

A 37-year-old with multiple sebaceous adenomas; one sebaceous carcinoma on eyelid. Which syndrome to consider?

A 70-year-old with thin erythematous plaque on calf; biopsy: superficial BCC. Non-surgical option?

A 45-year-old with nail unit pigmented band widening and periungual pigment. Next best step?

A 62-year-old immunocompetent man with frequent NMSCs asks about oral prevention. Evidence-based option?

A 69-year-old with scalp cSCC and numbness in distribution of the supraorbital nerve. Concern and step?

A 50-year-old with a pink papule; dermoscopy shows dotted vessels and white circles; biopsy: porocarcinoma. Management?

A 62-year-old with thin plaque-stage MF localized; desires non-drug option. Reasonable therapy?

A 73-year-old with multiple recurrent BCCs declines surgery. Systemic option?

A 73-year-old with a thick, tender “actinic keratosis” on the forearm that failed cryotherapy. Next best step?

A morpheaform BCC on the nasal ala was “excised” elsewhere; pathology: involved margins. Optimal management now?

A 58-year-old with metastatic melanoma on anti–PD-1 develops watery diarrhea >6/day and cramping. Initial management?

An 8-year-old (Fitzpatrick V) develops thin longitudinal melanonychia on multiple nails; no single band is changing. Best approach?

A 66-year-old with invasive SCC on the scalp has positive deep margin after standard excision. Next step?

A 64-year-old on vismodegib for laBCC complains of muscle cramps and altered taste. Counseling?

A 35-year-old pregnant woman (18 weeks) has a 1.2-mm non-ulcerated melanoma on the thigh. Node management?

A 79-year-old with periocular BCC receives adjuvant RT. Which late effect to counsel?

A 57-year-old with a 0.7-mm non-ulcerated melanoma asks about margins. Best answer?

A 68-year-old renal transplant recipient with multiple aggressive SCCs despite acitretin. Adjunctive systemic strategy?

A 61-year-old with a 1.8-cm ear SCC, poorly differentiated, 6 mm depth. What staging step is reasonable?

A 52-year-old with superficial BCC on trunk prefers non-surgical therapy. Most appropriate regimen?

A 70-year-old with patch-stage MF confined to buttocks. Best initial option?

A 29-year-old with changing pigmented macule; dermoscopy shows atypical network and streaks. Diagnostic approach?

A 63-year-old with Bowen disease (SCC in situ) on the pretibial leg where healing is poor. Reasonable first-line?

A 48-year-old with thin melanoma (0.9 mm) and ≥1 mitosis/mm², non-ulcerated. SLNB?

A 72-year-old with large field of AKs seeks short-course home therapy. Option to discuss?

A 67-year-old with pigmented facial macule diagnosed as lentigo maligna. Why staged excision/Mohs preferred?

A 59-year-old develops lichenoid papules after starting anti–PD-1 for melanoma. Skin-directed care?

A 40-year-old with a 2.5-mm ulcerated melanoma (T3b) and negative SLN post-excision. Adjuvant therapy?

A 62-year-old with a rapidly growing tender keratotic nodule on the hand; histology favors KA-type SCC. Management?

A 69-year-old with a firm bluish nodule on the scalp; biopsy: adnexal carcinoma with perineural spread. Best local control?

A 47-year-old with changing lesion on the sole; biopsy: acral lentiginous melanoma in situ. Margin recommendation?

A 55-year-old with subcutaneous nodules between primary melanoma and regional nodes. These are called?

A 71-year-old with new rapidly growing violaceous nodule on sun-exposed scalp; CK20 dot+, AE1/AE3+. First systemic option if unresectable?

A 37-year-old with numerous atypical nevi; shave of one shows severe dysplasia with positive margins. Best next step?

A 75-year-old with pruritic, crusted papules and plaques; biopsy: porokeratosis (cornoid lamella). Counseling?

A 56-year-old with a 1.0-cm nodular BCC on the cheek. What margin is usually adequate?

A 63-year-old with melanoma, BRAF V600E+, multiple symptomatic liver mets. Needs rapid response. Best initial systemic therapy?

A 50-year-old with a dome-shaped exophytic nodule on the scalp; biopsy: trichilemmal (pilar) cyst, proliferating type with atypia confined. Management?

A 28-year-old with a pigmented lesion on the thigh underwent deep shave; pathology: 0.8-mm melanoma, margins transected. Next step?

A 74-year-old with a pearly papule on the eyelid margin; biopsy: sebaceous carcinoma. Key workup/treatment?

A 62-year-old with pigmented lesion on cheek; dermoscopy: maple-leaf structures, spoke-wheel areas. Diagnosis?

A 71-year-old with 4-cm ulcerated SCC on lower lip, fixed node in level I. Best initial management?

A 59-year-old with melanoma in situ on the back after shave removal. Appropriate margin?

A 45-year-old with desmoplastic melanoma (2.1 mm) on scalp, neurotropism present, negative SLN. Adjuvant local measure?

A 60-year-old with multiple eruptive SKs and weight loss. Workup?

A 42-year-old with melanoma and injectable dermal/subcutaneous lesions not amenable to surgery. Local immunotherapy option?

A 55-year-old with numerous AKs on the scalp asks for prevention strategies. Best evidence-based advice?

A 70-year-old with a suspicious pigmented nail band widening over months and periungual pigment. Why matrix biopsy (not plate)?

A renal-transplant recipient develops dozens of new keratinizing tumors on sun-exposed skin despite photoprotection. Best chemopreventive step to add to dermatologic care?

A 67-year-old with a 4.5-mm ulcerated melanoma on the back underwent wide excision. Appropriate surgical margin?

Lentigo maligna (melanoma in situ) on the lower eyelid margin. Tissue-sparing approach?

A 1.3-mm non-ulcerated melanoma was excised with 1-cm margins, but pathology shows a positive peripheral margin. Next step?

A man with cheek pain, paresthesia in V2, and a history of cSCC near the infraorbital area. Concern and workup?

Desmoplastic melanoma (pure type) 2.0 mm on scalp, excised. What is true about nodal risk?

A rapidly enlarging, friable red papule on the finger bleeds easily after trauma. Histology: lobular capillary proliferation. Management?

A blue-black macule on the face with peppered granules and a scar from prior excision; dermoscopy shows gray dots and circles. Likely entity?

A 73-year-old with ulcerated SCC on the temple and palpable preauricular lymph node. Best immediate plan?

A woman has erythematous patchy “eczema” around the nipple for 6 months, unilateral, refractory to steroids. Next step?

A firm, freely mobile, painful subungual nodule causing cold sensitivity and point tenderness. Most likely diagnosis?

A 60-year-old with a new violaceous papule on the ear; dermoscopy shows arborizing vessels and shiny white structures; biopsy: BCC with perineural invasion. Post-Mohs adjuvant?

A 55-year-old with indurated plaque on the trunk; histology shows spindle-cell tumor, CD34+, COL1A1-PDGFB fusion. Best management?

A 42-year-old with pigmented lesion on the sole; dermoscopy shows parallel ridge pattern. Best step?

A 70-year-old with cutaneous angiosarcoma of scalp (bruise-like plaques). Adjunct to surgery?

A patient on anti–PD-1 for melanoma develops new depigmented macules on forearms. Counseling?

A 58-year-old with a 9-mm shiny papule on the nasal tip; patient declines surgery. Non-surgical option with highest clearance among topicals?

A 64-year-old presents with “peau d’orange” indurated erythema of the breast skin. Concern?

Painful dome-shaped pink nodule on the thigh; histology: well-circumscribed dermal tumor of smooth muscle. Diagnosis/management?

A patient with hundreds of SKs asks about sudden increase over months plus weight loss. What should you do?

A 59-year-old with suspicious changing nevus on back. Best biopsy technique?

A 76-year-old immunosuppressed man with tender keratotic nodule; biopsy: cSCC with bone invasion. Appropriate staging?

A 52-year-old with recurrent superficial BCC field on chest. Best field therapy if downtime should be minimal?

A man with scalp MF patch stage limited to crown asks for non-drug option.

A 68-year-old with pigmented facial lesion showing maple-leaf areas and spoke-wheel structures. Diagnosis?

Recurrent BCC after prior RT to the temple; unresectable. Systemic option?

A 61-year-old with eruptive KAs while on BRAF inhibitor. Why does this occur?

A 70-year-old with a pink, firm, dome-shaped nodule on scalp; pathology: atypical fibroxanthoma (AFX). Treatment?

A 56-year-old with a violaceous dermal nodule; biopsy: epithelioid angiosarcoma. Key prognostic factor?

Subungual pigmented band in a 45-year-old widens and becomes variegated; Hutchinson sign present. Management?

A 65-year-old with EMPD of the groin after wide excision asks about recurrence. Counseling?

A patient with metastatic melanoma, BRAF wild-type, rapidly progressive symptomatic disease. First-line systemic?

A 62-year-old with multiple AKs seeks a very short at-home regimen. Option?

A 48-year-old with clinically node-negative MCC of the forearm. What staging improves outcomes?

A 50-year-old with superficial spreading melanoma 1.4 mm, non-ulcerated. Recommended margins and nodal plan?

A 66-year-old with recurrent bleeding “wart” on the lower leg; pathology: porocarcinoma with lymphatic invasion. Next step?

A 39-year-old with a rapidly growing pink papule; dermoscopy: prominent arborizing vessels and ulceration; histology: basosquamous carcinoma. Management?

A 72-year-old with darkly pigmented lesion on the cheek; dermoscopy: circles-within-circles and gray dots on a hair follicle-rich area. Likely entity?

A 63-year-old with multiple facial field AKs and a shallow SCC in situ prefers minimal downtime. Best approach?

A 58-year-old with history of melanoma asks how cutaneous metastases typically present. Correct description?

A 58-year-old with a 1.9-mm non-ulcerated melanoma on the shoulder. Appropriate surgical margins and nodal plan?

A 73-year-old with multiple superficial BCCs on the trunk prefers an office procedure. Best option?

A 45-year-old with darkly pigmented facial macule; dermoscopy shows asymmetric network, blue-white veil, and atypical streaks. Next step?

A 69-year-old with rapidly enlarging violaceous tumor on leg; biopsy: Kaposi sarcoma, visceral symptoms present. Systemic therapy?

A 54-year-old with melanoma in situ on cheek (lentigo maligna). Best surgical approach?

A 62-year-old with a firm indurated plaque on trunk; biopsy: DFSP. Margins on standard excision?

A 71-year-old with a nodular BCC on medial canthus; patient declines surgery. Best non-surgical definitive option?

A 60-year-old with cutaneous SCC on ear helix, 1.5 cm, perineural invasion on biopsy. Key next step?

A 52-year-old with numerous atypical nevi and two relatives with melanoma before age 50. Counseling?

A 66-year-old with 0.7-mm non-ulcerated melanoma on calf asks about SLNB. Appropriate response?

A 48-year-old with MCC of the cheek, clinically node-negative. What staging improves outcomes?

A 74-year-old with rapidly growing crateriform nodule with keratin plug on forearm; pathology suggests KA-type SCC. Management?

A 63-year-old with erosive “eczema” of nipple unresponsive to steroids for 4 months. Next step?

A 58-year-old transplant recipient with relentless cSCCs despite acitretin. Systemic immunosuppression strategy?

A 69-year-old with a blue-black papule; dermoscopy: steel-blue homogeneous color, no network. Diagnosis?

A 55-year-old with multiple AKs on scalp asks for the shortest effective home field therapy. Option?

A 50-year-old with nodular melanoma, BRAF WT, symptomatic bulky disease. First-line systemic choice?

A 72-year-old with pigmented BCC on cheek; what dermoscopic clues support BCC?

A 41-year-old with a firm, painful subungual nodule; MRI suggests glomus tumor. Management?

A 67-year-old with desmoplastic melanoma 2.8 mm on scalp, neurotropism, negative nodes. Adjuvant local measure?

A 60-year-old with EMPD of groin treated by excision asks about surveillance. Best advice?

A 64-year-old with superficial BCC on chest prefers medication. Which has strongest evidence among topicals?

A 59-year-old with in-transit melanoma metastases in limb not amenable to surgery. Limb-directed option?

A 53-year-old with rapidly growing ulcerated nodule on ear; biopsy: poorly differentiated cSCC. Prognostic high-risk features?

A 71-year-old with numerous eruptive SKs and pruritus over months. What should you check first?

A 47-year-old with atypical Spitz tumor excised from thigh; positive deep margin. Best next step?

A 65-year-old with rapidly growing violaceous head/neck plaques; biopsy: cutaneous angiosarcoma. Systemic option?

A 56-year-old with porokeratosis (cornoid lamella) on shin asks about cancer risk. Counseling?

A 62-year-old with melanoma 3.4 mm, ulcerated, positive SLN. Adjuvant systemic therapy?

A 70-year-old with actinic cheilitis refractory to topicals. Definitive management?

A 59-year-old with an adnexal tumor showing ductal differentiation and perineural invasion. Likely tumor/management?

A 66-year-old on anti–PD-1 for melanoma develops pruritic lichenoid papules. Skin-directed care while continuing therapy?

A 51-year-old with acral pigmented lesion; dermoscopy shows parallel ridge pattern and irregular blotches. Best step?

A 75-year-old with recurrent BCC after two surgeries, not a surgical candidate. Systemic therapy?

A 63-year-old with MF patch/plaque stage progressing to tumors with nodal involvement. Next-line therapy?

A 68-year-old with pigmented lesion on face; dermoscopy shows gray circles around follicles and asymmetry. Differential/plan?

A 57-year-old with a shiny pink papule; histology: basosquamous carcinoma. Why high-risk?