USMLE CK Quiz # 4
USMLE Step 2 Examination;
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1. Question
A 50-year-old man comes to the physician because of an unusual appearing mole on his upper back. He says that his wife has noted a recent change in its color and shape. The lesion measures 0.7 cm and has ill-defined margins and irregular pigmentation. The patient is otherwise healthy and takes no medication. Which of the following is the most appropriate next step in management?
CorrectAnswer & Rationale:
Option F is correct answer
The correct answer is F. The gross appearance of the lesion, along with its recent changes over a presumably short period, is highly suggestive of malignant melanoma. The proportion in which melanomas arise from pre-existing benign nevocellular nevi is not known. In the dysplastic nevus syndrome, however, a dysplastic nevus-melanoma sequence is well established. Nevertheless, an excisional biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features: asymmetric or fuzzy border, irregular or variegated color, and diameter greater than 0.6 cm. According to the American Cancer Society, the mnemonic ABCD may serve to recall the most important suspicious signs: Asymmetry, Border irregularity, Color variegation, and Diameter >0.6 cm. Bleeding and ulcerations are malignant signs, albeit far less frequent. Melanoma is the most common cause of death due to skin malignancies. Physicians can play a crucial role in prevention by referring to dermatologists patients who have moles with such suspicious features. The initial approach to a suspicious mole or clinically obvious melanoma consists of total excision (excisional biopsy) with a small margin. If a diagnosis of melanoma is confirmed pathologically, wider margins are excised on a second operation.
IncorrectAnswer & Rationale:
Option F is correct answer
The correct answer is F. The gross appearance of the lesion, along with its recent changes over a presumably short period, is highly suggestive of malignant melanoma. The proportion in which melanomas arise from pre-existing benign nevocellular nevi is not known. In the dysplastic nevus syndrome, however, a dysplastic nevus-melanoma sequence is well established. Nevertheless, an excisional biopsy should be carried out in any case of pigmented skin lesion that shows one or more of the following features: asymmetric or fuzzy border, irregular or variegated color, and diameter greater than 0.6 cm. According to the American Cancer Society, the mnemonic ABCD may serve to recall the most important suspicious signs: Asymmetry, Border irregularity, Color variegation, and Diameter >0.6 cm. Bleeding and ulcerations are malignant signs, albeit far less frequent. Melanoma is the most common cause of death due to skin malignancies. Physicians can play a crucial role in prevention by referring to dermatologists patients who have moles with such suspicious features. The initial approach to a suspicious mole or clinically obvious melanoma consists of total excision (excisional biopsy) with a small margin. If a diagnosis of melanoma is confirmed pathologically, wider margins are excised on a second operation.