Male 64 years

1 cm eyelid lesion


The characteristic immunoprofile of this lesion is:


A. BerEP4 positive, ER negative, synaptophysin negative

B. CK7 negative, CK20 positive, CDX2 negative, synaptophysin positive

C. CK7 positive, synaptophysin negative, CK20 negative, BerEp4 negative

D. CK7 negative, Isl-1 positive, synatophysin positive

E. CK7 positive, ER positive, synaptophysin positive

Male 44 years

Rapid onset of multiple papules on the trunk and extremities, stable, sparing palms and soles.


Which is the best panel of antibodies to confirm the diagnosis?


A. CD3+, CD8+, CD20-, CD 30-, BF1+, TCR-gamma-

B. CD3+, BF 1+, CD 4-, CD 8+, CD30+

C. CD3+, CD4-, CD 8+, TIA 1+, granzyme B+, CD 56-, CD30-, BF1+

D. CD3+, CD4-, CD8+/+, TIA 1+, EBV-, CD56+, TCR-gamma+

E. CD 3+, CD4-, CD 8+, TIA1+, BF1+, CD56-, EBV-

Male 60 years

Solitary, uniformly pigmented papule on the chest.


Regarding BAP1, what of the following is correct?


A. All lesions with loss of BAP1 expression by immunohistochemistry are malignant

B. In lesions with loss of BAP1 expression, there is no concomitant expression of BRAF V600E

C. Patients with BAP1 mutation may have other malignancies apart from melanoma, e.g., mesothelioma

D. Loss of BAP1 expression has no correlation with BAP1 mutation

E. BAP1-deficient lesions are primarily intraepidermal with only small dermal component

Female 41 years

62 x 30 mm deeply located lesion on the thigh. The lesion had been present for more than one year and was clinically considered to be a lipoma.

Which of the following is correct regarding this entity?


A. This is a benign lesion characteristically occurring in the distal extremities

B. This lesion characteristically has translocations involving the FUS or CREB3 genes

C. The lesions have uniform, large, hypercellular fascicles, with numerous mitotic figures

D. If metastasis occur, they happen shortly after diagnosis

E. Cells are uniformly positive for S100 protein and SOX10

Male 65 years

Patient with intermittent fevers and chills for 1 week, telangiectatic and erythematous macules over the chest for 2 months, and significant loss of weight over 6 months.


A. Intravascular large B-cell lymphoma

B. Intravascular NK/T cell lymphoma

C. Intravascular/Intralymphatic histiocytosis

D. Reactive angioendotheliomatosis

Male 65 years

Patient presented with a tender eruption over both feet for two months, in association with polyarticular inflammatory arthralgia of the small joints of the hands and intermittent fevers. There was weight loss of seven kilograms over five months. He had an elevated erythrocyte sedimentation rate of 128 mm/hr. Examination revealed non-palpable retiform purpura over both feet.

A. Anti-phospholipid syndrome

B. Cholesterol embolism

C. Cryocrystalglobulinaemia

D. Disseminated intravascular coagulopathy

Female 48 years

Patient with asymptomatic, dark brown and scaly eruptions over bilateral axillae for 18 months.


A. Dermatophytosis

B. Flexural psoriasis

C. Granular parakeratosis

D. Pityriasis rubra pilaris

Female 72 years

Patient with mildly itchy erythematous plaques over bilateral forearms for 1 year.


A. Chromoblastomycosis

B. Coccidiodomycosis

C. Cryptococcosis

D. Protothecosis

Male 70 years

Lesion left lateral calf, pigmented lesion, excision.


A. Blue naevus

B. Nodular melanoma

C. Clonal naevus

D. Spitzoid melanoma

Male 79 years

4x6mm warty nodule present 2/12 left chest


A. Keratoacanthoma

B. Squamous cell carcinoma (follicular variant)

C. Proliferative actinic keratosis

D. Trichoepithelioma

Female 73 years

Polypoid nodule excised


A. Storiform collagenoma

B. Keloidal scar

C. Acral fibrokeratoma

D. Fibromatosis

Female 80 years

Recurrent lesion from scalp


A. Squamous cell carcinoma

B. Merkel cell carcinoma

C. Porocarcinoma

D. Metastatic renal cell carcinoma

Male 6 years

Depigmented patch with a slightly raised rim, left upper back.


A. Pityriasis versicolor

B. Vitiligo

C. Erythema annulare centrifugum

D. Mycosis fungoides

Male 77 years

Excision of ulcerated exophytic nodule left shoulder. Previous curettage and subsequent excision of poorly differentiated squamous cell carcinoma with background changes of squamous cell carcinoma in situ in 2015 with clear margins at the same site. Past history of multiple SCC, BCC, renal cell carcinoma (2004), nodular melanoma (2003). Post renal transplant on immunosuppression.


A. Porocarcinoma

B. Metastatic renal cell carcinoma

C. Squamous cell carcinoma

D. Clear cell hidradenocarcinoma

Female 70 years

Minimally depressed, lightly pigmented patches posterior shoulder and left abdomen. Biopsy from shoulder lesion.


A. Normal skin (inadequate sampling)

B. Post-inflammatory hyperpigmentation

C. Morphoea

D. Amyloidosis

Male 38 years

"Atypical" mole 5x5mm posterior shoulder getting darker. ? Dysplastic naevus ? Melanoma.


A. Blue naevus

B. Clonal naevus

C. Spitz naevus

D. Deep penetrating naevus

Female 27 years

Punch biopsy dorsum left hand. Asymptomatic annular erythematous scaly patches on the dorsum of the left hand and medial aspect of the left foot.


A. Pityriasis lichenoides chronica

B. Extramammary Paget's disease

C. Pagetoid reticulosis

D. Discoid eczema

Male 73 years

Punch biopsies from: dorsum right hand (supplied); left medial eyebrow; midline of back; and right flank. Indurated waxy plaque on skin for 3/12. Found associated monoclonal gammopathy


A. Nephrogenic systemic sclerosis

B. Papular mucinosis / scleromyxoedema

C. Metastatic adenocarcinoma

D. Generalised myxoedema

Female 30 years

Excision biopsy skin nodule right mid thigh anterior surface.


A. Cellular neurothekeoma

B. Nerve sheath myxoma

C. Schwannoma

D. Malignant melanoma

Female 50 years

Several months of right pinna swelling, subcutaneous tissue from right pinna


A. Langerhans cell histiocytosis

B. Reticulohistiocytoma

C. Juvenile xanthogranuloma

D. Cutaneous Rosai-Dorfman disease

Female 30 years

Newly diagnosed with HIV infection. Hospital admission for suspected infective endocarditis. Subsequent evolution of painful, yellowish papules and small nodules on the face and the tongue over 4 days.

A. Septic vasculitis

B. Cryptococcoid neutrophilic dermatosis

C. Cryptococcosis

D. Granuloma faciale

E. Pustular drug eruption

Female 25 years

Recently diagnosed with HIV infection. Marked CD4 lymphopaenia. Multiple facial nodules and plaques.

A. Histoplasmosis

B. Leishmaniasis

C. Cutaneous pneumocystosis

D. Emergomycosis

E. Disseminated cutaneous sporotrichosis

Male 42 years

Necrotic lesion debrided from the scalp of patient with insulin-dependent diabetes mellitus.

A. Gouty panniculitis

B. Pancreatic panniculitis

C. Atypical mycobacterial infection

D. Alpha-1 Antitrypsin deficiency-associated panniculitis

E. Mucormycosis

Male 42 years

Patient with HIV infection. Poorly compliant on antiretroviral therapy, with a high viral load and severe CD4 lymphopaenia. Tender cutaneous nodules present on the limbs and abdomen, some ulcerated. Associated malaise, headache, uveitis and bilateral pulmonary infiltrates.

A. Blastomycosis

B. Cytomegalovirus infection

C. Entamoeba histolytica infection

D. Malignant histiocytosis

E. Acanthamoeba infection

Male 70 years

Solitary, slowly growing nodule on the right ear. Excision biopsy done.


A: Basal cell carcinoma

B: Neuroendocrine carcinoma

C: Sebaceoma

D: Metastatic adenocarcinoma

Male 26 years

Several erythematous nodules on the chest. Punch biopsy done.


A: Folliculitis

B: Mastocytosis

C: Langerhans cell histiocytosis

D: Cutaneous Rosai Dorfman disease

Male 54 years

Cyst upper lip.


A: Spindle cell squamous carcinoma

B: Spindle cell melanoma

C: Dermatofibrosarcoma protuberans

D: Solitary fibrous tumour

Male 70 years

Rapidly developing pain and swelling arms and legs. Biopsies from skin and fascia left thigh.


A: Eosinophilic fasciitis

B: Deep morphoea

C: SPT Cell Lymphoma

D: Toxic oil syndrome

Female 34 years

Rash on chest, 5 years in duration. On examination three orange/red nodules; the largest of which 15mm in diameter on the left chest wall.


Immunohistochemistry: Lymphocytes predominantly CD3+ and scattered CD20+ cells, histiocytic cells CD163+, CD1a+ and occassional S100+ cells


A. Langerhans cell histiocytosis

B. Indeterminate cell histiocytosis

C. Xanthogranuloma

D. Rosai-Dorfman disease

Male 52 years

Lesion right palm.


Immohistochemistry:

+ SMA, desmin

- S100, Melan-A, CD34, Stat-6 and AE1/3


A. Myofibroma

B. Leiomyoma

C. Glomus tumour

D. Myopericytoma

Male 67 years

Lesion left flank.


Immunohistochemistry:

+ p16, cyclin D-1, BAP-1

- Pan-TRK


A. Desmoplastic melanoma

B. Desmoplastic spitz naevus

C. Spitzoid melanoma

Female 50 years

Previous breast carcinoma with radiotherapy.


Petechial rash skin left chest wall.

Immunohistochemistry: CD117+ cells within dermis


A. Cutaneous mastocytosis

B. Radiotherapy field change

C. Morphea

D. Normal skin

Male 42 years


Recurrent lumps on his back over several years.


Immunohistochemistry demonstrated a CD79a(+) CD138(+) phenotype and kappa light chain restriction.


Which of the following is true in this case?


A. Up to 10% of patients have an associated cardiomyopathy


B. Light chain restriction proves monoclonality


C. The prognosis is excellent


D. Bcl-2 is usually negative


E. The plasmacytoid cells are most likely to express IgM

Male 25 years


Biopsy from right thigh: ? SLE, psoriasis, eczema, MF


Which of the following is true of this disease?


A. There is often clinical alopecia


B. The neoplastic cells are usually CD8(+)


C. It is associated with rapid clinical progression


D. There is usually clinical hyperhidrosis


E. It responds well to topically-directed therapy

Male 61 years


3 month papulo-squamous rash. Biopsy from abdomen.


Which of the following is true in this diagnosis?


A. Immunofluoresence will demonstrate intercellular IgG


B. The disease is linked to chromosome 3q


C. Lichenoid inflammation is a well-documented feature


D. Mucosae are often affected


E. Serum vitamin A will be low

Female 53 years


Pearly nodule left temple: ?BCC


Immunohistochemistry demonstrated a CD3(-) CD5(-) CD79a(+) CD20(+) bcl-6(+) bcl-2(+) MUM-1(+) IgM(+) c-Myc(+/-) phenotype with admixed CD23(+) foci.


Which of the following is the best diagnosis?


A. Diffuse follicle centre cell lymphoma


B. Diffuse Large B-cell Lymphoma, Leg Type


C. Diffuse Large B-cell Lymphoma NOS


D. Diffuse Large B-cell Lymphoma, Other


E. Richter's transformation of chronic lymphocytic leukaemia

Male 83 years

Slow onset of bullous eruption in patient with known subacute lupus erythematosus. Biopsy taken from neck.


A. Pityriasis lichenoides et varioliformis acuta (PLEVA)

B. Bullous pemphigoid

C. Toxic epidermal necrolysis-like rash of lupus

D. Discoid lupus erythematosus

Male 54 years

1 year history of lesions on both legs, erythema nodosum? (Significant additional history found after telephone call to clinician). Biopsy lower leg.


A. Follicular mucinosis

B. Pretibial myxoedema / thyroid dermopathy

C. Superficial angiomyxoma

D. Scleredema

Female 33 years

Mildly atypical naevus on back, incomplete excision. Now conservative re-excision of scar from back.


A. Recurrent naevus / pseudomelanoma

B. Melanoma in situ

C. Extra-mammary Paget's disease

D. Atypical junctional naevus

Female 54 years

Brown skin lesion upper back. Grown quickly.


A. Dermatofibrosarcoma protruberans

B. Aneurysmal fibrous histiocytoma

C. Metastatic melanoma

D. Angiomatoid fibrous histiocytoma