Female 50 years

Diploma case.

Indurated lump on left labia. Referred to gynae outpatients with suspected LSA that did not improve with steroids. No history of change in bowel habits.


What is the likely diagnosis?

A. Cutaneous Crohn's.
B. Small B cell neoplasm (?extra nodal MZL with plasmacytic differentiation).
C. Syphilis.
D. Lichenoid eruption for clinical correlation (genital LP).

Male 33 years

Diploma case.

7 month history of tender purple ulcerated plaque right forearm 23x22mm. History of follicular occlusion syndrome with 2 years history of erythematous rash on torso, slightly itchy and associated with ulcerated lesions.

? Acne conglobata / HS

?pyoderma gangrenosum.


Scarring from cyst. Incisional biopsy through edge.


What is the likely working diagnosis?

A. Folliculitis.
B. Pyoderma gangrenosum.
C. Vasculitis.
D. Angiocentric lymphoma such as angioimmunoblastic T-cell lymphoma.
E. Leukaemia cutis.

Female 69 years

FRCPath / Dermatology SCE case.

5mm punch biopsy left neck. 20mm Warty lesion 6/52.

?infected seb wart.

?SCC.


The likely working diagnosis?

A. LCH.
B. Transformed MF
C. Pseudolymphoma / lymphomatoid drug eruption.
D. ALCL / LyP.
E. Cutaneous involvement by CHL.

Male 57 years

FRCPath / Dermatology SCE case.

Firm non-tender purplish dermal lumps up to 12mm on face and upper back. Resolving spontaneously.

?Jessner's but unusually infiltrative and palpable.

??Sarcoid. ???Lymphomatoid papulosis (unusual presentation).
Left cheek and right neck bxs.


Which of the following statements is accurate for this lesion?

A. This is a reactive process.
B. This is a clonal process.
C. This is curable / complete regression can be induced medically.
D. Collision of different pathologies can be found in the same diagnostic material.
E. Any combination of the above.

Male 28 years

FRCPath / Dermatology SCE case.

Warty lesion occipital scalp.


A. Sebaceous hyperplasia.
B. Sebaceous adenoma.
C. Naevus sebaceous.
D. Viral wart.

Female 86 years

Diploma case.

Tender papillomatous eruption right eyelid. H/O rheumatoid arthritis and suspected sarcoidosis treated with systemic corticosteroids and methotrexate. Had not left the UK in last 2 decades but history of travel overseas prior to that.


A. Cutaneous sarcoidosis.
B. Leishmaniasis.
C. Histoplasmosis.
D. Eruptive xanthoma.

Male 43 years

FRCPath / Dermatology SCE case.

Erythematous scaly patches on trunks and limbs.


A. Pityriasis rubra pilaris.
B. Psoriasis.
C. Chronic eczematous dermatitis.
D. Pityriasis lichenoides chronica.

Female 75 years

Diploma case.

H/O myelodysplasia. Slow growing incidental patch of hair loss occipital scalp noted 10yrs ago. ?DLE ?LPP. Several inconclusive biopsies in the past. Now slightly indurated ?infiltrative BCC.


A. Scar tissue.
B. Atypical fibroxanthoma.
C. Radiotherapy changes.
D. Superficial / plaque-like DFSP.

Male 76 years

FRCPath / Dermatology SCE case.

Nodule on forehead growing for three years.

Immunohistochemistry: + CEA, +GCDFP15, +Estrogen and progesterone receptors.


A. Cribriform apocrine carcinoma.
B. Hidradenocarcinoma.
C. Apocrine carcinoma.
D. Metastatic adenocarcinoma.

Female 84 years

FRCPath / Dermatology SCE case.

Nodule on lower lip. ?SCC. ?BCC.

Immunohistochemistry: Focal CEA positivity


A. Squamous cell carcinoma.
B. Squamoid ductal eccrine carcinoma.
C. Microcystic adnexal carcinoma.
D. Basosquamous carcinoma.

Male 70 years

Diploma case.

4 year-history rash on forearms and left thigh.

Special stain: EVG.


A. Granuloma multiforme.
B. Granuloma annulare.
C. Actinic granuloma.
D. Elastolytic giant cell granuloma.

Male 26 years

Diploma case.

Lesion dorsum of right hand.

Immunohistochemistry: S100 protein, melan-A, HMB45 and SOX10 positive.


A. Cellular blue naevus.
B. Metastatic melanoma.
C. Dermal clear cell sarcoma.
D. Cutaneous melanocytoma with CRTC1-TRIM11 fusion.

Male 53 years

Diploma case.

Rapidly growing nodule on forehead.


A. Sebaceous carcinoma.
B. Basosquamous carcinoma.
C. Combined Merkel cell carcinoma and squamous cell carcinoma.
D. Metastatic lung carcinoma (small cell carcinoma).

Male 90 years

FRCPath / Dermatology SCE case.

10 x 5cm patch right chin. ?Bowen's versus SCC. Past history multiple myeloma and SCC.

A. Herpes virus infection.
B. Pemphigus vulgaris.
C. Nocardiasis.
D. Superficial granulomatous pyoderma gangrenosum.

Male 42 years

Diploma case.

Ingrowing hair on chin.

A. Tick with surrounding pseudocyst.
B. Cutaneous synovial cyst.
C. Cutaneous myxoid cyst.
D. Apocrine hidrocystoma.

Female 63 years

FRCPath / Dermatology SCE case.

8mm ?blue naevus ?melanoma left calf.


A. Combined common acquired naevus and cellular blue naevus.
B. Nodular melanoma arising in atypical compound naevus.
C. Atypical spiztoid tumour.
D.Combined common acquired naevus and deep penetrating naevus.

Male 50 years

FRCPath / Dermatology SCE case.

3/12 history of isolated plaque dorsum L hand.
Wade-Fite stain positive.


Identify the most likely organism.

A. Mycobacterium chimarea.
B. Mycobacterium tuberculosis.
C. Mycobacterium marinum.
D. Mycobacterium avium intercellulare.

Male 40 years

Diploma case.

Longstanding purpuric rash on chest. Increased numbers of CD117 positive cells with clustering around blood vessels.


Identify the most likely diagnosis.

A. Urticaria pigmentosa.
B. Urticarial vasculitis.
C. Telangiectasia macularis eruptive perstans.
D. Leukaemia cutis.

Male 58 years

Diploma case.

Dusky area of erythema on thigh with slight epidermal atrophy 18/12. Elastin stain (EVG) shows loss of fibres in the lesional area.


Identify the most likely diagnosis.

A. Kaposi sarcoma.
B. Hobnail haemangioma.
C. Arteriovenous malformation.
D. Poikilodermatous plaque like haemangioma.

Male 84 years

FRCPath / Dermatology SCE case.

New nodule arising within area of longstanding disease L groin.


Identify the most likely immunoprofile.

A. GATA3 +, CK7 +, CK20 -.
B. MelanA +, S100 +, SOX10 +.
C. CD20 +, CD79a +, BCL2 +.
D. TTF1 +, synaptophysin +, CAM5.2 +.

Female 53 years

Diploma case.

Renal transplant patient with a tumour on the back. Clinical impression epidermoid cyst. SMA positive, very focally positive for desmin and h-caldesmon.


A. Cutaneous leiomyoma.
B. Leiomyosarcoma.
C. EBV-associated smooth muscle neoplasm.
D. Myofibroma.

Male 69 years

Diploma case.

Lesion on the right medial upper eyebrow. ?BCC (biopsies x2).


A. Folliculitis.
B. Follicular mucinosis.
C. Granuloma faciale.
D. Angiolymphoid hyperplasia with eosinophilia.

Male 64 years

FRCPath / Dermatology SCE case.

Nasal tip lesion. ?lymphoproliferative disorder ?Infectious. CD31 positive


A. High grade lymphoma.
B. Idiopathic angiosarcoma.
C. Epithelioid angiosarcoma.
D. Histiocytic sarcoma.

Female 58 years

Diploma case.

History of right knee replacement in 2008 followed by gradual worsening rash over the years on the right lower leg.


A. Intralymphatic histiocytosis.
B. Glomeruloid haemangioma.
C. Kaposi sarcoma.
D. Lupus erythematosus.

Male 58 years

FRCPath / Dermatology SCE case.

M58 Punch biopsy skin left chest.
? photo sensitive eruption
? GVHD following a stem cell transplant 200 days ago.


A. Graft versus host disease.
B. Polymorphic light eruption.
C. Mycosis fungoides.
D. Leukaemic infiltrate.

Female 79 years

FRCPath / Dermatology SCE case.

Incisional biopsy right thigh. Long standing rash. Biopsy from a nodule.


A. Lupus.
B. Mycosis fungoides.
C. Chronic actinic dermatitis.
D. Mycosis fungoides with large cell transformation.

Male 37 years

Diploma case.

Incisional biopsy left lower leg. H/O Liver transplant. Purple, painful nodules and some haemorrhagic bullae.


A. Pancreatic panniculitis.
B. Calciphylaxis.
C. Monckeberg's medial calcific sclerosis.
D. Polyarteritis nodosa.

Male 3 years

Diploma case.

Biopsies from the buccal mucosa and skin of abdomen.
H/O recurrent oral ulceration and skin ulceration.


A. Amyloidosis.
B. Porphyria.
C. Cutaneous collagenous vasculopathy
D. Lipoid proteinosis.

Female 32 years

FRCPath / Dermatology SCE case.

Subcutaneous mass left breast.


Lesional cells of this condition stain with:
A. CD30, CD1a, S100.
B. p16, CD1a, Langerin.
C. CD117, IgG4, CD1a.
D. Oct 2, Cyclin D1, S100.
E. S100, Melan A, SOX 10.

FRCPath / Dermatology SCE case.

Slides 518018/518060: Patient was 44 years old at the time of biopsy, Mass involving mandible and overlying skin.

Slide 518020: 9 week old baby, unusual papular rash with scales on top ? Seborrhoeic dermatitis.

Slide 518021: 34Y/F, Lesion scalp- ? SCC, Separate lesion vulva- previous history of granulomatous inflammation in pituitary 12 years ago.


The most frequently mutated gene in the entity pictured in these slides is:
A. BRAF pV600e.
B. N/ KRAS.
C. MAP2K1.
D. in-frame fusions BRAF.
E. PIK3CA.

Diploma case.

Slide 518024: 12 Y/F Multiple cutaneous lesions, excision biopsy submental nodule.

Slide 518025: 2/y F Multiple nodules scalp 9 months.


According to the Histiocyte Society classification, the entity represented in these images falls into which group?
A. L group.
B. C group.
C. R group.
D. M group.
E. H group.

Male 80 years

Diploma case.

Excision ? basal cell carcinoma right axilla, history of CLL.


The proposed theory/ies for molecular transformation of B-cell lymphoma to histiocytic or dendritic cell neoplasms include:
A. Direct transdifferentiation of neoplastic B-cells into malignant histiocytes or dendritic cells.
B. Involves a two-step process of transformation with first de-differentiation of neoplastic B-cells to early progenitors and subsequent re-differentiation along the histiocytic/dendritic lineage.
C. Presence of a common neoplastic progenitor with differentiation along both B-cell and histiocytic/dendritic lineages at different times.
D. All of the above.

Female 51 years

Diploma case.

Presented with soft wrinkly skin, initially red patchy maculopapular rash under bra strap
? urticaria/vasculitis.

Tired, hypermobile, dysfunctional pelvis, IgG paraprotein.

Incision biopsy lower back.

EVG: loss of elastic fibres in the mid dermis.


What is the most likely diagnosis?
A. Cutis laxa.
B. Ehlers Danlos syndrome.
C. Pseudo xanthoma elasticum.
D. Scleromyxoedema.

Male 54 years

FRCPath / Dermatology SCE case.

Painful nodule L ear ?SCC.


What is the most likely diagnosis?
A. Chondrodermatitis nodularis helicis chronica.
B. Gout.
C. Rheumatoid nodule.
D. Squamous cell carcinoma.

Female 15 years

Diploma case.

Linear warty skin L trunk and leg since age 2 months


What is the most likely diagnosis?
A. Epidermolytic epidermal naevus.
B. Inflammatory linear verrucous epidermal naevus.
C. Incontinentia pigmenti.
D. Mosaic Darier's disease.

Male 50 years

FRCPath / Dermatology SCE case.

Long-standing cough.

Necrotic discharging nodule L thigh ? granulomatous ? infective.

The large cells express MUM-1, CD30, CD45, Granzyme B and perforin.


What is the most likely diagnosis?

A. CD30+ anaplastic large cell lymphoma.
B. Lymphomatoid papulosis type C.
C. Large cell transformation of mycosis fungoides.
D. Peripheral T- cell lymphoma NOS with cutaneous involvement.

Female 34 years

Diploma case.

Long- term Azathioprine for autoimmune hepatitis.
?acne, ?contact allergic rash ? seborrhoeic dermatitis.

Punch biopsy from face.


A. Rosacea.
B. Fungal infection.
C. Azathioprine induced granulomatous and suppurative folliculitis.
D. Contact dermatitis.

Diploma case.

The patient had cardiac arrest.? Aspiration pneumonia. Number of pale blue/black macular lesions following arterial distribution.? Septic emboli.? Cholesterol emboli.

Punch biopsy left arm.


A. Traumatic tattoo.
B. Argyria.
C. Embolus.
D. Contrast medium deposition.

Male 54 years

FRCPath / Dermatology SCE case.

Right calf excision of "cyst".


A. Cellular dermatofibroma.
B. Melanoma.
C. Dermatofibrosarcoma protuberans.
D. Leiomyoma.

Male 55 years

FRCPath / Dermatology SCE case.

WLE of biopsy proven tumour on scalp.


A. Apocrine cystadenoma.
B. Porocarcinoma.
C. Nodular hidradenoma.
D. Trichoepithelioma.