Male 61 years

Pendulous lesion nose. Exclude malignancy.


A: Fibrous papule.

B: Rosacea.

C: Fibroepithelial polyp.

D: Superficial angiomyxoma.

Male 47 years

Tender nodule forearm. US possibly vascular but indents on fascia.


A: Angioleiomyoma.

B: Schwannoma.

C: Angiomyolipoma.

D: Pilar leiomyoma.

Female 65 years

Oedema and redness left breast. H/O Wide local excision, sentinel lymph node biopsy and radiotherapy 4 yrs ago. ? Tumour recurrence ? Radiotherapy related oedema.


A: Granuloma annulare.

B: Radiation dermatitis.

C: Morphoea.

D: Syphilis.

Female 54 years

H/O End stage renal failure on dialysis with microvascular complications. Three year H/O tender keratotic papules lower legs with crusting and surrounding erythema.


A: Nodular prurigo.

B: Perforating dermatosis.

C: Calciphylaxis.

D: Keratosis pilaris.

Female 67 years

Cystic nodule right index finger.


A: digital papillary adenocarcinoma.

B: hidradenoma.

C: hidradenocarcinoma.

D: mixed tumour of skin (chrondroid syringoma).

Female 64 years

Slate grey discolouration ?acrocyanosis, ?haemochromatosis, ?drug induced due to anti-epileptic drug levetiracetam or over the counter silver elixir. Biopsy of cheek skin.


A: haemochromatosis.

B: drug-induced hyperpigmentation.

C: argyria.

D: melasma.

Male 4 years

Left wrist 1 month history of rapid growth ?atypical Spitz naevus, ??haemangioma.


A: ALK fusion Spitz naevus.

B: BAP1-inactived melanocytoma.

C: spitzoid melanoma.

D: deep penetrating naevus.

Male 57 years

Paraphimosis. Circumcision.


A: syphilis.

B: orf.

C: anaplastic large cell lymphoma.

D: transformed mycosis fungoides.

Female 66 years

L right flank - deep nodule. Nature unclear. No relevant medical history.


A: Solitary fibrous tumour

B: Synovial sarcoma

C: Myopericytoma

D: Inflammatory myofibroblastic tumour

Female 61 years

Dermal papule L cheek ?inflammatory ?non melanoma skin cancer ??lymphoma


A: Lichenoid drug eruption

B: Granulomatous rosacea

C: Leishmaniasis

D: Reaction to filler

Female 83 years

Persisting painful erythematous plaque on L lower leg ?cause


A: Stasis dermatitis

B: Polymorphous light eruption

C: Poikilodermatous plaque like haemangioma

D: Reaction to an arthropod assault

Female 38 years

Ongoing hair loss, non scarring clinically. Possible miniaturisation ?FPHL+CTE. Some perifollicular inflammation ?LPP


A: Traction alopecia

B: Granulomatous alopecia areata

C: Sarcoidosis

D: Mycobacterial infection

Female 70 years

Incisional biopsy left calf. Patient presented with a necrotic, sloughy and ulcerated wound to the right calf. She has known end stage renal failure on peritoneal dialysis.


Identify the correct diagnosis

A: Drug induced ulceration.

B: Cholesterol embolism syndrome.

C: Calciphylaxis.

D: Systemic vasculitis.

Female 28 years

Incisional biopsy right forearm. Presented with a 2 week history of a pruritic urticated rash on the trunk and limbs with blistering. It began shortly after a caesarean section. An immunofluorescence specimen was also received and showed strong linear deposition of C3c along the BMZ.


Identify the correct diagnosis

A: Bullous pemphigoid.

B: Lupus erythematosus.

C: Epidermolysis bullosa acquista.

D: Pemphigoid gestationis.

Male 40 years

Excision biopsy left breast ?BCC. (Section provided is adjacent to the clinical tumour). Patient presented with a nodular lesion of the left breast, clinically diagnosed as basal cell carcinoma. An excision biopsy was performed (the section represents skin adjacent to the tumour).


Identify the diagnosis NOT associated with the acquired variant of this condition:

A: Solid organ transplantation.

B: Lymphoma.

C: HIV infection.

D: End stage renal failure.

Female 20 years

Punch biopsy axilla, Skin coloured papules ?atypical KP, ?lichen nitidus, ?acanthosis nigrans. Presented with multiple skin coloured papules in the axilla and trunk. A biopsy was taken.


Identify the most appropriate serological investigation based on the biopsy findings:

A: Lipid profile.

B: Urea and electrolytes.

C: Liver function tests.

D: Serum zinc levels.

Male 80 years

Excision of large tumour posterior scalp, follicular tumour.


A: Proliferating pilar tumour.

B: Malignant proliferating pilar tumour.

C: Trichilemmal carcinoma.

D: Squamous cell carcinoma.

Male 66 years

Excision lesion scalp, pilar cyst or proliferating pilar tumour.


A: Dermal nerve sheath myxoma.

B: Neurothekeoma.

C: Acral myxoid fibrosarcoma.

D: Myxoid neurofibroma.

Male 49 years

Excision of raised peduncular lesion left knee, dermatofibroma/benign/lipoma.


A: Lipoma.

B: Scar and reactive changes.

C: Adenolipoma.

D: Atypical lipomatous tumour.

Female 58 years

Excision of rapidly growing lump posterior neck ?aggressive vascular tumour.


A: Basaloid squamous cell carcinoma.

B: Follicular carcinoma.

C: Pilomatrical carcinoma.

D: Squamous cell carcinoma.

Female 3 years

Nodule to left hip. No progression in size for past one year.


Question: Which of the following is the best diagnosis?

A: Cutaneous leiomyoma.

B: Connective tissue naevus.

C: Smooth muscle hamartoma.

D: leiomyosarcoma.

Male 56 years

Excision nodule neck.


Question: Which of the following is the best diagnosis?

A: Juvenile Xanthogranuloma.

B: Langerhan's cell histiocytosis.

C: Cutaneous lymphoid hyperplasia.

D: Cutaneous Rosai Dorfman Disease.

Male 71 years

Boggy, itchy, tender scalp. 18 month history. Punch biopsy.


Question: Which of the following is the best diagnosis?

A: Erosive pustular dermatosis.

B: Folliculitis decalvans.

C: Atypical lymphoid infiltrate.

D: Pseudo-lymphomatous angiosarcoma.

Female 93 years

A 10 mm nodular lesion noted in the left axilla. Excised.


Question: Which of the following is the best diagnosis?

A: Adenoid Cystic carcinoma.

B: Tubular adenoma.

C: Cribriform Carcinoma.

D: Metastatic carcinoma from the breast.

Male 77 years

Patient with a history of hepatocellular carcinoma, presenting with a reticulated macular pigmentation over the chest and upper abdomen.


A: Crystalglobulinemia.

B: Cutaneous embolism from drug-eluting bead transarterial chemoembolization (DEB-TACE) therapy.

C: Intravascular large B cell lymphoma (IVLBCL).

D: Migration of dermal filler composed of polymethylmethacrylate (PMMA) microspheres.

Male 83 years

History of endogenous eczema, ischaemic heart disease, hyperlipidaemia, hypertension, gout and renal impairment. Presents with an asymptomatic persistent rash over right forearm for 1 month.


A: Non-tuberculous mycobacterial infection.

B: Phaeohyphomycosis.

C: Prothecosis.

D: Ruptured epidermal cyst with suppurative granulomatous inflammation.

Female 17 years

Recurrent bilateral tender non-ulcerated plaques and nodules on the dorsa of the feet and shins for 1 year. Patient was otherwise healthy with no fever or cough.


A: Granulomatosis with polyangiitis.

B: Granulomatous phlebitis.

C: Polyarteritis nodosa.

D: Rheumatoid nodule.

Male 80 years

Persistent rash over the gluteal cleft with intermittent itch for 2 years.


A: Acroangiodermatitis.

B: Lichen simplex chronicus.

C: Microvenular hemangioma.

D: Reactive Epidermal hyperplasia and Angiogenesis of the Rear (REAR).

Female 15 years

?Haemangioma in the axilla

IHC: CD99+. Patchy SMA positivity.

AE1/AE3, CAM5.2, CD31, CD34, Desmin, Caldesmon, S100, Melan A, HMB45, SOX10, D2-40, ALK1, CEA and EMA are negative.


Which of the following is true regarding this tumour?

A: Location in the skin is associated with a more indolent progression.

B: NGS sequencing is the usual definitive diagnostic test.

C: They are derived from the nerve sheath.

D: The skin is a preferred site for metastasis.

Female 47 years

5mm papule on wrist.

IHC:.

Positive: S100, SMA, p63 (very weak and focal)
Negative: AE1/AE3, Cam5.2, BerEP4, melan-A, SOX10, HMB45, Factor XIIIa, D240, ALK (CD246), ALK D5F3 clone, CD34, CD31, desmin, calponin, CD1a, langerin.
.

What is the most likely diagnosis?

A: Neurothekeoma.

B: Myoepithelioma.

C: Melanoma.

D: Fibrous histiocytoma.

Female 70 years

Incisional biopsy from leg. Recent bone marrow biopsy.


What test would be most helpful in securing the diagnosis?

A: CD56.

B: Warthin Starry.

C: Kappa/Lambda ISH.

D: CD45.

Female 29 years

Past history of lupus nephritis. Rash.


What is the most likely diagnosis?

A: Graft vs host disease.

B: Cutaneous involvement by lupus.

C: Dermatomyositis.

D: Lichen planus.

Female 83 years

Perianal plaques and discomfort. On examination evidence of bilateral discharging groin lesions and perianal lesions. High suspicion of malignancy.


Identify the most likely statement:

A: Is commonly associated with antibodies against Desmoglein 3.

B: PAS or Grocott is useful to highlight septate hyphae.

C: Is commonly associated with antibodies against Desmocollin 1.

D: Cornoid lamella may be poorly formed.

Male 75 years

Right lateral lower leg. Rapidly enlarging bleeding nodule now 20mm ?BCC?SCC?Angiosarcoma.


Identify the most likely diagnosis:


A: Glomus tumour.

B: Malignant glomus tumour.

C: Symplastic glomus tumour.

D: Atypical glomus tumour.

Male 50 years

Left upper thigh biopsy. PMH multiple myeloma. Multiple subcutaneous nodules.


Identify the most likely statement:

A: The plasma cells in the infiltrate are consistently monoclonal.

B: Is infrequently associated with paraproteinemia.

C: Is frequently associated with diabetes mellitus.

D: The plasma cells in the infiltrate are consistently polyclonal.

Male 54 years

Right calf biopsy. PMH CLL. ?BP


Identify the most likely statement:


A: Direct immunofluorescence is positive for IgG and C3.

B: Is most frequently associated with CLL.

C: A type of arthropod bite reaction.

D: Is most frequently associated with DLBCL.

Male 48 years

Swelling on scalp. Incisional biopsy. ? Sarcoid ? Lymphoma.


What is the diagnosis?

A: Discoid lupus.

B: Lymphoma, T-cell.

C: Sarcoid.

D: Lymphoid hyperplasia.

Male 13 years

Three week history of widespread papular rash.


What is the diagnosis?


A: Insect bite.

B: Herpes simplex infection.

C: Pityriasis lichenoides chronica.

D: Drug reaction.

Male 74 years

Right forearm incisional biopsy. Intermittent painful, deep inflammation - likely panniculitis. ?malignancy, ?CTD.


A: Erythema nodosum.

B: Pancreatitis related fat necrosis.

C: Erythema induratum.

D: VEXAS syndrome.

Female 31 years

Upper back ? Cyst.

Immunostains - S100, CD34 and ALK1 positive. SOX10 negative. SMA, Desmin and cytokeratins all negative.


A: Low grade malignant peripheral nerve sheath tumour.

B: Solitary fibrous tumour.

C: Superficial ALK-rearranged myxoid spindle cell neoplasm.

D: Spitz naevus.