Female 26 years

Patient with TAR syndrome (thrombocytopenia + absent radius) presented with vulvar and perianal lesions since 2002, which had been diagnosed of Langerhans cell histiocytosis and treated with corticosteroids, methotrexate and mercaptopurine. She had also long-standing papular lesions on the lower extremities.


The best diagnosis is:

A.
Langerhans cell histiocytosis and multiple dermatofibromas

B. Langerhans cell histiocytosis and multiple reticulohistiocytomas

C. Langerhans cell histiocytosis and multiple juvenile xanthogranulomas

D. Langerhans cell histiocytosis and Rosai-Dorfman disease

Male 82 years

Patient with history of adenocarcinoma of the colon that had been surgically excised 2 years before presented with eyelid swelling and muscular weakness of 9 months duration.

The best diagnosis is:

A. Periorbital mucinosis and lupus erythematosus

B. Lupus panniculitis

C. Paraneoplastic dermatomyositis with hemophagocytosis

D. Subcutaneous panniculitic T-cell lymphoma.

Female 32 years

Patient had been diagnosed with adult-onset of Still's disease presented with fever, polyarthralgia, and persistent, erythematous, slightly scaly papules with somewhat linear configuration on the chest and upper extremities.

The best diagnosis is:

A. Darier's disease

B. Grover's disease

C. Incidental hypergranulotic dyscornification

D. Persistent cutaneous eruption of adult-onset Still's disease.

Female 41 years

Presented with a pigmented lesion on the scalp. The lesion had been present since birth.

The best diagnosis is:

A. Dermal melanocytosis causing cutis verticis gyrata

B. Cutis verticis gyrata and residual hyperpigmentation

C. Cutis verticis gyrata and dermal melanoma

D. Cutis verticis gyrata and cellular blue nevus.

Female 65 years

B symptoms, lymphadenopathy, scalp alopecia and occipital ulcer.

The best diagnosis is:

A. Kikuchi disease

B. Infection

C. Giant cell arteritis

D. Dermatitis artefacta.

Female 48 years



The best diagnosis is:

A. Pemphigus

B. Darier's disease

C. Pyostomatitis vegetans

D. Chronic ulcerative stomatitis.

Female 17 years

Scalp alopecia.

The best diagnosis is:

A. Alopecia areata

B. Androgenic alopecia

C. Telogen effluvium

D. Trichotillomania.

Male 55 years

Buttock.

The best diagnosis is:

A. Hookworm

B. Tick

C. Thorn

D. Strongyloides.

Female 60 years

Longstanding history of recurrent bullae on erythematous base, not responding to steroids. Multiple previous biopsies with variable picture. Direct IMF: Focal granular C3 along dermo-epidermal junction. Indirect IMF: negative.

The best diagnosis is:

A. Bullous pemphigoid with epidermal necrosis

B. Bullous Erythema Multiforme

C. Bullous Dermatitis Artefacta

D. Allergic contact dermatitis.

Male 71 years

Telangiectatic rash to abdomen.

The best diagnosis is:

A. Essential telangiectasia

B. Telangiectasia macularis eruptiva perstans (TMEP)

C. Porphyria/Pseudoporphyria

D. Cutaneous Collagenous Vasculopathy.

Female 45 years

Livedoid rash on legs extending to thighs, with associated induration.

The best diagnosis is:

A. Scleromyxoedema

B. Scleroderma with PXE- like changes

C. Non uraemic calciphylaxis with PXE like changes

D. Livedoid vasculopathy.

Female 50 years

Multiple grouped whitish papules on cheeks.

The best diagnosis is:

A. Fibrofolliculoma/Trichodiscoma

B. Fibrous Papule

C. Basaloid Follicular proliferation

D. Trichofolliculoma.

Female 66 years

7-8 year history of slow growing mass left temple.

The best diagnosis is:

A. Myopericytoma

B. Dermatofibrosarcoma protuberans

C. Solitary fibrous tumour

D. Spindle cell haemangioma.

Male 28 years

Solitary plaque posterior aspect of thigh.

The best diagnosis is:

A. Granular cell tumour

B. Reaction to soft tissue filters

C. Dermatofibroma

D. Cutaneous metastasis.

Male 70 years

Itchy photosensitive rash trunk following PUVA treatment for psoriasis. Looks different from psoriasis.

The best diagnosis is:

A. Cutaneous lupus

B. Sweet syndrome

C. Small vessel leukocytoclastic vasculitis

D. Non-tuberculous mycobacterial infection.

Male 71 years

Keratotic lesion scrotum.

The best diagnosis is:

A. Naevus sebaceous

B. Syringometaplasia

C. Viral wart

D. Syringocystadenoma papilliferum.

Male 77 years

? metastasis left parotid. Previous scalp SCC.

The best diagnosis is:

A. Primary mucoepidermoid carcinoma

B. Metastatic squamous cell carcinoma

C. Metastatic trichilemmal carcinoma

D. Primary squamous cell carcinoma.

Male 79 years

Excision lesion right tibia. Previous melanoma. ? metastatic deposit. Previous treatment with Talimogene laherparepvec (T-VEC).

The best diagnosis is:

A. Metastatic malignant melanoma

B. Sarcoidosis

C. Atypical mycobacterial infection

D. Granulomatous regression reaction.

Male 82 years

Patient with chronic lymphocytic leukaemia with haemorrhagic blister dorsum of hand. ?paraneoplastic, ?leukaemia cutis, ?pyoderma gangrenosum.

The best diagnosis is:

A. Nocardia infection

B. Pyoderma gangrenosum

C. Bullous Sweet's syndrome

D. Atypical mycobacterial infection.

Male 62 years

Thick keratotic nail plate middle finger forming a nodule.

The best diagnosis is:

A. Onychopapilloma

B. Superficial acral fibromyxoma

C. Onychomatricoma

D. Onychomycosis.

Female 59 years

2 years history of increased pigmentation on cheek? Ashy dermatosis ? Lichen planus pigmentosus ? Ochronosis ? Chronic actinic dermatitis.

The best diagnosis is:

A. Post inflammatory hyperpigmentation

B. Drug induced hyperpigmentation

C. External ochronosis

D. Melasma.

Female 32 years

Tissue from the right foot ? ganglion. Specimen received is a light-brown colour tissue 12 x 8 x 8mm.

The best diagnosis is:

A. Malignant Melanoma

B. Pigmented Dermatofibrosarcoma protuberans

C. Pigmented Neurofibroma

D. Psammomatous melanotic schwannoma.

Male 12 years

History of soft tissue lump on the back for 4 years. Specimen received is a 40 x 35 x 10mm lobulated lump which is fatty on cut surface.

The best diagnosis is:

A. Hibernoma

B. Lipobastoma

C. Myxoid liposarcoma

D. Chondroid lipoma.

Female 68 years

Large elevated irregular plaque on right upper arm. Previous history breast lump 14mm in diameter.

The best diagnosis is:

A. Granuloma faciale

B. Erythema elevatum diiutinum

C. Chronic fibrosing vasculitis

D. Sweet's syndrome.

Male 81 years

Past medical history of prostate cancer (2013) treated with Zoladex and RTX. He presents with longstanding diffuse keratoderma, which is deteriorating. A raised PSA was noted - ? Paraneoplastic keratoderma.

The best diagnosis is:

A. Paraneoplastic keratoderma

B. IgG4 disease

C. Pachydermatous eosinophilic dermatitis

D. Psoriasis

E. Syphilis.

Female 54 years

Ulceration on anterior thighs. Recent forefoot amputation for presumed diabetes. Normal renal function.

The best diagnosis is:

A. Pyoderma gangrenosum

B. Calciphilaxis

C. Kaposis' sarcoma

D. Angiosarcoma

E. Reactive angioendotheliomatosis.

Female 23 years

Multiple small micro-discoid plaques with erythematous rim and central white area scattered over upper arm and back, with predilection for tattoos.

The best diagnosis is:

A. Discoid lupus erythematosus

B. Thrombotic disorder

C. Degos' disease

D. Sarcoid

E. Artefact.

Male 32 years

Longstanding pigmentary change since teens - hyperpigmentation background and hypopigmented atrophic macules: hyperkeratotic 2-4 mm papules on extensor surfaces and back, sparing chest and relatively sparing face.

The best diagnosis is:

A. Epidermodysplasia verruciformis

B. Xeroderma pigmentosum

C. Dyskeratosis congenita

D. Amyloidosis

E. Lichen planus.

Female 55 years

Incisional biopsy central lower abdomen.
Firm, indurated nodule below umbilicus in old laparotomy scar (with another smaller nodule above it). Clinically resembles calciphylaxis but X-ray of abdomen did not reveal any soft tissue calcification.

The best diagnosis is:

A. Epithelioid melanoma

B. Angiosarcoma

C. Granulation tissue

D. Anaplastic T cell lymphoma

E. Metastatic carcinoma.

Female 68 years

Excision from left arm. 10mm red plaque left forearm (previous brown mole, bled and changed 2/12 ago). To rule out MM.

The best diagnosis is:

A. Kaposi sarcoma (lymphangitic variant)

B. Hobnail haemangioma

C. Acquired elastolytic haemangioma

D. Post-radiation atypical vascular proliferation

E. Sinusoidal haemangioma.

Male 28 years

Incisional biopsy left thigh. Recent cocaine use, vasculitis, vasculitic rash in areas with necrosis ?

The best diagnosis is:

A. Herpes virus infection

B. Nodular Vasculitis

C. Sweet's syndrome

D. Calciphylaxis

E. Levimasol-induced ulcer.

Female 34 years

Incisional biopsy right upper arm. ? GA ? erythema annulare centrifugum ? Wells disease ? necrobiotic xanthogranuloma ? urticarial vasculitis. O/E annular progressive rash.

The best diagnosis is:

A. Urticarial vasculitis

B. Well's syndrome

C. Churg Strauss vasculitis

D. DRESS syndrome

E. Cercarial dermatitis.

The following molecular signal is likely to be found in this tumour:

A. MYC amplification

B. NTRK fusion

C. Increased copy number of 11q13

D. NRAS mutation

E. GNAQ mutation.

Which one of the following is NOT true of this tumour?

A. The face and neck are the commonest anatomic sites

B. It is associated with mutations in the Beta-catenin gene

C. Metastases arise in 40-50% of cases

D. It rarely shows lymphovascular invasion

E. Usually presents as a slow-growing nodule.

Which of the following statements is correct regarding this adnexal tumour?

A. It is pathognomic of Brooke Spiegler syndrome

B. Immunoexpression of p63 is associated with malignancy

C. Vascular invasion is well-documented in benign tumours

D. Is congenital in 2% of cases

E. Is likely of apocrine lineage.

In considering this tumour, which of the following conclusions can be drawn?

A. This tumour type often regresses following biopsy

B. Cutaneous leukaemia should be considered

C. The patient is probably immunosuppressed

D. The patient has mycosis fungoides

E. The atypia is too pronounced for a reactive process

Male 38 years

Pustules and rash central face. Failed to respond to antibiotics.

The best diagnosis is:

A. Acne

B. Sweet's syndrome

C. Pyoderma faciale

D. Staphylococcus folliculitis.

Female 20 years

Intermittent rash and fever. Relapse on cessation of etanercept.

The best diagnosis is:

A. Systemic lupus

B. Erythema annulare centrifugum

C. Tumour necrosis factor periodic fever syndrome

D. Jessner's lymphocytic infiltrate.

Female 22 years

Holiday in Venezuela. Mass removed from sole of foot.

The best diagnosis is:

A. Tungiasis

B. Schistosomiasis

C. Bot fly infestation

D. Cysticercosis.

Female 52 years

10 yr history of papules. Biopsy from thigh.

The best diagnosis is:

A. Darier's disease

B. Pemphigus vulgaris

C. Grover's disease

D. Galli-Galli disease.