Male 66 years

Cardiac patient. Right sub-scapular area. Well defined indurated/sclerotic focally ulcerated plaque with atrophic areas of 2 years duration.

The best diagnosis is?

A. Bullous morphea

B. Lichen sclerosus

C. Fluoroscopy induced chronic radiodermatitis

D. Erythema ab igne

Female 37 years

Papulo-nodular eruption on erythematous base, some are ulcerated. Located on upper arms, both legs up to buttocks.

Best Diagnosis is:

A. PLEVA

B. Suppurative folliculitis

C. Papulo necrotic tuberculide

D. Suppurative palisading granuloma

Male 68 years

History of progressive IgG lambda multiple myeloma and chronic kidney disease presents with acute renal failure requiring hemodialysis and a rash on bilateral soles and palms associated with pain present for 3 weeks.

Based on the patient's history and the histologic findings, what is the most likely diagnosis?

A. Calciphylaxis

B. Septic vasculitis

C. Perniosis

D. Crystaloglobulinemia

E. Cholesterol emboli

Female 30 years

Left thigh, from Lima, likes to eat ceviche. She presented with a nodule that, 2 weeks after, moved 3 cm. and became a plaque.

The best diagnosis is?

A. Sparganosis

B. Gnathostomiasis

C. Cutaneous Larva Migrans

D. Dracunculiasis

Male 48 years

Multiple skin-coloured papules on the dorsum of the hands and wrists, present for several years.

The best diagnosis is?

A. Cutaneous focal mucinosis

B. Scleromyxoedema

C. Multiple cutaneous myxomas

D. Acral persistent papular mucinosis

Male 69 years

Infiltrative tumour of the right leg. HIV+ patient, Kaposi sarcoma treated with radiotherapy and bleomycine, sudden onset of infiltrative tumour.

The best diagnosis is?

A. Undifferentiated sarcoma

B. Angiosarcoma

C. Anaplastic Kaposi sarcoma

D. Metastatic carcinoma

Female 82 years

ATCD : Thyroidectomy (nodules), hysterectomy(fibroma), pulmonary Tuberculosis. Since 10 years, large erosive painful plaque of vulva, perineum, pubis, inguinal folds with some recent vegetating lesions on the vulva / No adenopathy / No hepato or splenomegaly. Biopsy of a vegetating lesion of the vulva.

The best diagnosis is?

A. Hailey Hailey disease

B. Syringocystadenocarcinoma papilliferum in situ

C. Acantholytic extramammary Paget's disease

D. Acantholytic pagetoid Bowen disease

Male 12 months

Right flank, firm violaceous plaque which had developed at 8 weeks of age.

The best diagnosis is?

A. Dermatofibroma

B. Dermatofibrosarcoma protuberans

C. Myofibroma

D. Plaque-like myofibroblastic tumour (of infancy)

Male 14 years

Patient presented with a new onset diffuse vesiculobullous rash with cutaneous and oral, urethral, and conjunctival mucosal involvement, which was felt to be clinically highly suspicious for erythema multiforme (EM)/Stevens Johnson syndrome (SJS).

The best diagnosis is?

A. Interface/bullous drug reaction

B. Bullous pemphigoid

C. Bullous erythema multiforme (EM)/Stevens Johnson syndrome (SJS)

D. Bullous arthropod bite reaction

Male 26 years

Right cheek excision, Rule out BCC versus Cyst.

The best diagnosis is?

A. Clear Cell Syringoma

B. Clear cell variant of BCC

C. Lymphoepithelial-like carcinoma of the skin.

D. Cutaneous lymphadenoma

E. Ameloblastoma

Female 30 years

Hispanic female presented to our clinic with an itchy lesion on the right elbow that had been present for several months. The patient is immunocompetent and attributed the lesion to an insect bite which had preceded the lesion.

The best diagnosis is?

A. Sporotrichosis

B. Protothecosis

C. Paracoccidiodomycosis

D. Blastomycosis

E. Coccidiodomycosis

Female 71 years

Arm, history of acute myelogenous leukemia, status post allogeneic stem cell transplant with history of acute graft versus host disease, now presenting with thickened taut skin on the lower extremities, left arm, abdomen, rule out GVHD, scleroderma, amyloidosis, lymphedema.

The best diagnosis is:

A. Graft versus host disease

B. Lymphedema

C. Macular amyloidosis

D. Scleroderma

Female 70 years

Lesions on the abdomen. Clinical differential diagnosis was not provided.

The best diagnosis is?

A. Granuloma annulare

B. Benign fibrous histiocytoma

C. Granuloma annulare-like metastatic breast carcinoma

D. Interstitial granulomatous dermatitis

Male 33 years

Left forearm, recurring punctate purpura due to minor trauma.

The best diagnosis is?

A. Amyloidosis

B. Porphyria

C. Lipoid proteinosis

D. Light chain deposition disease

Male 9 years

Nephrotic syndrome. Purpuric lesions on the dorsum of the hands, later on both earlobes.

The best diagnosis is?

A. Levamisole-induced occlusive vasculitis

B. Churg-Strauss syndrome

C. Meningococcal sepsis

D. Kawasaki syndrome

Male 51 years

Patient presents with purpura, arthralgia and weakness. A skin biopsy shows densely eosinophilic material in blood vessel lumina which is strongly Periodic acid Schiff (PAS) stain positive and diastase resistant.

Identify the most likely diagnosis.

A. Leukocytoclastic vasculitis

B. Cryoglobulinaemia

C. Thrombotic thrombocytopenic purpura

D. Warfarin necrosis

E. Disseminated intravascular coagulopathy

Male 84 years

Papillomatous frontal lesion.

The best diagnosis is?

A. Trichofolliculoma

B. Hamartoma

C. Panfolliculoma

D. Epidermal panfolliculoma

Female 87 years

Lesion left lower leg. Fungating tumour ?SCC - Excised close to fascia.

The best diagnosis is?

A. Baso squamous carcinoma

B. Collision tumour - Melanoma and Squamous cell Carcinoma

C. Collision tumour - Melanocytic Matricoma and squamous cell Carcinoma

D. Collision Tumour - Pilomatricoma and squamous cell carcinoma

Female 24 years

Presented with a necrotic lesion on her right elbow. The clinical diagnosis was "rule out pyoderma gangrenosum, leishmaniasis, vs other?" She recently returned from a trip to Lebanon. She reported having similar lesions in the past, that self-resolve.

The best diagnosis is?

A. Reactive perforating collgenosis due to excoriation

B. Leishmaniasis

C. Cutaneous gamma delta T cell lymphoma

D. Lymphomatoid papulosis

Male 75 years

Presented with an ulcerating tumour on his left upper arm. The clinical impression was pyogenic granuloma. The patient does not have history of autoimmune condition, and neither of chronic immunosuppressive drug use, such as methotrexate.

The best diagnosis is?

A. Herpes infection

B. Insect/arthropod bite reaction

C. Pyoderma gangrenosum

D. Lymphomatoid papulosis with 6p25.3 rearrangement

Female 2 years

Lesion on lower back, left flank and buttock, linear hypopigmented atrophic macules with few telangiectasia since birth, with no associated systemic anomaly.

The best diagnosis is?

A. Incontinentia pigmenti

B. Focal dermal hypoplasia

C. Ectodermal dysplasia

D. Linear atrophoderma of Moulin

Male 51 years

Diagnosed with CLL. Started on chemotherapy for progressive disease. 5 months following initiation of therapy, patient developed a polymorphic rash with papules, nodules and blisters. Bx from left leg.

The best diagnosis is?

A. Drug reaction

B. Insect bite reaction

C. Prebullous pemphigoid

D. Eosinophilic dermatois of haemtological malignancy

E. Well's syndrome

Female 60 years

Presented with bilaterally thickened skin on her hands and digits. There was no history of trauma.

The best diagnosis is?

A. Acrokeratoelastoidosis of Costa

B. Focal acral hyperkeratosis

C. Collagenous and elastotic marginal plaques of the hands

D. Hyperkeratotic palmoplantar psoriasis

Female 19 years

Sudden appearing of papulovesicular lesions, firstly affecting perioral area with spreading to face, hands and foot (including palms and soles). Sore throat the day before starting the skin lesions without fever, cool-sores or other symptoms. On examination, a papulovesicular eruption affecting those areas was found. On her hands and feet, the lesions tended to present an annular shape.

The best diagnosis is?

A. Atypical hand-foot and mouth disease.

B. Varicela

C. Multifocal Orf.

D. Erythema multiforme

Female 65 years

Warty lesion right chest wall. Past history of breast carcinoma 12 years previously.

The best diagnosis is?

A. Sebaceous hyperplasia

B. Sebaceoma

C. Sebaceous adenoma

D. Sebaceous carcinoma

Male 3 years

Punch biopsy from back lesion. Multiple brown to hyperpigmented lesions scattered over the body. Duration of one year. Intermittently pruritic.

The best diagnosis is?

A. Langerhans Cell Histiocytosis

B. Mastocytosis

C. Lichen Planus

D. Melanocytic Nevi/Lentiginosis

E. Cutaneous Plasmacytosis/Secondary Syphilis

Female 27 years

Mobile, non-fluctuant swelling dorsum of foot. ? lipoma.

The best diagnosis is:

A. Naevoid melanoma

B. Glomus tumour

C. Epithelioid Schwannoma

D. Epithelioid malignant peripheral nerve sheath tumour

Male 67 years

New onset renal impairment. Several month history of arthralgia and tender ulcers and some flesh-colored papulonodules on extensor surfaces and buttocks. Background history of ischemic heart disease (post CABG), aortic aneurysm, type 2 diabetes mellitus and gout, on multiple medications, including allopurinol. pANCA (anti-MPO) and anti-GBM antibodies were detected. Urinalysis revealed red cell casts. A 4mm punch biopsy was taken of a papule on his left elbow.

The best diagnosis is?

A. Gouty tophus

B. Palisaded neutrophilic and granulomatous dermatitis

C. Sweet syndrome

D. Necrobiosis lipoidica

Male 45 years

Gluteal biopsy. 10 year history of progressive itchy flat topped papules and warty plaques on both buttocks.

The best diagnosis is?

A. Condyloma Acuminatum

B. Neurodermatitis

C. Inflammatory Linear Verrucous Epidermal Naevus (ILVEN)

D.Porokeratosis ptychotropica

Female 69 years

Presented an asympomatic thickening of the nail plate of the second finger of right hand for three years. At clinical examination thickened and yellowish nail plate was observed with longitudinal grooves and transversal hypercurvature.

The best diagnosis is?

A. Onychopapilloma

B. Onychomycosis

C. Onychomatricoma

D. Nail squamous cell carcinoma

Male 58 years

Nodule back, no other history on request form.

The best diagnosis is?

A. Metastatic prostatic adenocarcinoma

B. Metastatic neuroendocrine carcinoma

C. Malignant cylindroma

D. Primary eccrine ductal carcinoma

Male 48 years

Eerythematous plaques all over the body. Bullous lesions seen on fingers. Biopsies done from plaque and bullous lesion.

The best diagnosis is?

A. Bullous Mycosis fungoides

B. Mycosis fungoides with secondary bulla formation

C. Leukemic infiltration with secondary bulla formation

D. B cell Lymphomatous infiltration with bulla formation

Male age unknown

Presented with an erythroderma with fever, and edema of the limbs. Clinical examination revealed inguinal adenopathies. Blood cell count and smears analyses disclosed and hypereosinophilia with presence of hyperbasophilic lymphocytes. He had a slight increase of hepatic enzymes (<2N).

The best diagnosis is?

A. Sezary syndrome

B. Erythrodermic psoriasis

C. Drug reaction - drug rash with eosinophilia and systemic symptoms (DRESS)

D. Angioimmunoblastic T-cell lymphoma

Female 2 years

Presented with a left distal ring finger mass.

The best diagnosis is?

A. Angiosarcoma

B. Papillary intraepithelial angioendothelioma (PILA)

C. Juvenile hemangioma

D. Anaplastic large cell lymphoma

Female 63 years

A solitary, slowly enlarging, patch with scaly borders on the her palm for 15 years, resistant to topical treatments.

The best diagnosis is?

A. Porokeratosis

B. Palmar Psoriasis

C. Circumscribed hypokeratosis

D. Bowen disease

Male 83 years

Nodule on scalp with adjacent keratotic area. The nodule was an atypical fibroxanthoma. This is the adjacent skin.

The best diagnosis is?

A. Perforating collagenosis in a solar keratosis

B. Necrotising infundibular crystalline folliculitis in a solar keratosis

C. Debaryomyces hansenii infection in solar keratosis

D. Secondary localised cutaneous amyloidosis in a solar keratosis

Male 68 years

Cutaneous excision, face, BCC?.

The best diagnosis is?

A. Melanocytic naevus in a patient with argyria

B. Melanocytic naevus in a patient with endogenous ochronosis

C. Melanocytic naevus in a patient with severe cholestasis

D. Melanocytic naevus with dermal filler

Female 42 years

5-year history of an erythematous, scaly and slightly atrophic plaque on the right fore-head at the border of the scalp, with a well-defined edge, more than 5 cm in diameter, asymptomatic.
The best diagnosis is?

A. Necrobiotic Xanthogranuloma

B. Atypical Facial Necrobiosis Lipoidica

C. Lupus erythematosus

D. Granuloma annulare

Female 48 years

Caucasian female, shave biopsies from left axilla. The clinician described several apparently discrete lesions that were suspected to represent seborrheic keratoses or warts.

The best diagnosis is?

A. Lichen planus-like keratosis

B. Malignant melanoma in situ with regression

C. Mycosis fungoides

D. Lichen planus pigmentosus-inversus

Female 57 years

R hand; widespread dyspigmentation on torso and limbs; some lesions with raised, erythematous border.

The best diagnosis is?

A. Lupus erythematosus

B. Fixed drug eruption

C. Erythema dyschromicum perstans

D. Lichen planus

E. Erythema chronicum migrans

Female 35 years

Vulva, ?cyst 2 weeks post partum.

The best diagnosis is?

A. Fibroadenoma

B. Fibroadenoma with lactation changes

C. Phyllodes tumour

D. Hidradenoma papilliferum

Female 69 years

1-month evolution of a soft and painful nodule on the scalp. History of breast carcinoma 16-y ago.
Clinical diagnosis: Thrombosed hemangioma vs. cutaneous metastasis.

The best diagnosis is cutaneous metastasis. What is the origin?

A. Breast

B. Kidney

C. Thyroid

D. Lung

Female 33 years

Subcutaneous nodules in tattoo. Punch biopsy back.

The best diagnosis is?

A. Sarcoidal tattoo reaction

B. Sarcoidosis in tattoo

C. Infection with granulomatous inflammation in tattoo

D. Resolving traumatised follicle in tattoo

Male 82 years

Right upper back, excision: non-healing lesion ?BCC. No previous history of radiotherapy.

The best diagnosis is?

A. Morphoea

B. Lichen sclerosus

C. Chronic radiation damage following cardiac catheterisations

D. Chronic graft-versus-host disease

Male 18 years

Presented with history of recurrent papular rash on the face since one year and swelling of left knee since 6 months. He also has T-cell and B-cell combined immunodeficiency. Skin biopsy taken from the face shows numerous yeast or spore forms of fungi 2-10 microns in size
a) If the fungi shows broad based budding with morules, what is your diagnosis?
b) If the fungi are PAS positive, GMS positive and Mucicarmine negative what is your diagnosis?
c) If the fungi show spherules containing numerous endospores measuring 5 microns to 15 microns in size what is your diagnosis?
d) If the fungi show broad based budding but no morula formation what is your diagnosis?

Male 40 years

Triathlon followed by vomiting and photosensitive erythematous and peeling rash that evening.

The best diagnosis is?

A. Lupus

B. Drug reaction

C. Polymorphous light eruption

D. Cyanobacteria poisoning

Female 46 years

Liver transplant patient with a 5 year history of chronic febrile cholangitis. Since 6 months, recurrent episodes of high fever followed at the resolution by the development of pink papules, nodules and plaques on the face and acral extremities. The lesions were poorly responsive to antibiotic therapy and tended to recur and persist with discontinuation of antibiotic therapy.

The best diagnosis is?

A. Cutaneous amoebiasis

B. Chronic septic vasculitis with malakoplakia

C. Proteothecosis

D. Cryptococcosis

Female 32 years

Presented with a 4 mm pink papule with eccentric pigment globules and dotted vessels on dermoscopy, located on her right antecubital fossa. The patient has a history of multiple basal cell carcinomas, nevi with architectural disorder and cytologic atypia ("dysplastic"), combined nevi, and nevi with desmoplastic features.

The best diagnosis is?

A. Combined melanocytic nevus

B. Melanocytic nevus with loss of BAP1 ("BAPoma")

C. Spitz nevus

D. Melanoma arising in association with an intradermal nevus

Female 32 years

Dome-shaped, asymptomatic, pink tumor, well circumscribed, on the left heel, months of evolution.

The best diagnosis is?

A. Eccrine poroma

B. Amelanotic malignant melanoma

C. Primary cutaneous Ewing's sarcoma

D. Merkel cell carcinoma

Male 79 years

Asymptomatic ulceration on the thigh for 6 months; HIV2 +, under antiretroviral and tuberculostatic therapy for the last year; Past history of neurosyphilis.

The best diagnosis is?

A. Histoplasmosis

B. Blastomycosis

C. Syphilis

D. Cryptococcosis