Dermatologist Certificate Skin Cancer Pathology and Oncology 2 — Questions and Answers
Question 1: Merkel cell carcinoma is a neuroendocrine tumor associated with which viral pathogen?
- Merkel cell polyomavirus (MCPyV) (Correct answer)
- Human papillomavirus (HPV)
- Epstein-Barr virus (EBV)
- Human herpesvirus 8 (HHV-8)
Correct answer: Merkel cell polyomavirus (MCPyV)
Merkel cell polyomavirus DNA is integrated in approximately 80% of Merkel cell carcinomas, and viral oncoproteins (T antigens) contribute to tumorigenesis by inactivating tumor suppressors.
Question 2: What histological hallmark differentiates Bowen disease (SCC in situ) from invasive SCC?
- Full-thickness epidermal dysplasia without invasion through the basement membrane (Correct answer)
- Perineural invasion
- Lymphovascular invasion
- Keratin pearl formation
Correct answer: Full-thickness epidermal dysplasia without invasion through the basement membrane
Bowen disease shows full-thickness dysplasia of the epidermis with preserved basement membrane — by definition, carcinoma in situ has not breached the basement membrane to invade the dermis.
Question 3: Kaposi sarcoma is associated with which herpesvirus, and which patient population is classically affected in epidemic KS?
- HHV-8 (KSHV); patients with advanced HIV/AIDS (Correct answer)
- EBV; organ transplant recipients
- HHV-6; elderly Mediterranean men
- CMV; immunosuppressed patients
Correct answer: HHV-8 (KSHV); patients with advanced HIV/AIDS
Human herpesvirus 8 (Kaposi sarcoma-associated herpesvirus) causes all forms of KS; epidemic KS affecting HIV-positive patients with AIDS was the most prevalent form during the AIDS epidemic.
Question 4: Extramammary Paget disease most commonly affects which anatomical sites?
- Vulva, perianal region, and scrotum (Correct answer)
- Face and scalp
- Trunk and extremities
- Axillae and neck
Correct answer: Vulva, perianal region, and scrotum
Extramammary Paget disease presents as erythematous, eczematous plaques with large clear (Paget) cells and may be associated with an underlying adnexal or visceral adenocarcinoma.
Question 5: Which of the following is a high-risk feature of SCC that significantly increases metastatic potential?
- Tumor diameter >2 cm, depth >2 mm, perineural invasion, or immunosuppression (Correct answer)
- Presence on trunk
- Lesion arising de novo rather than from actinic keratosis
- Age <50 at diagnosis
Correct answer: Tumor diameter >2 cm, depth >2 mm, perineural invasion, or immunosuppression
High-risk SCC features include large size (>2 cm), deep invasion (>2 mm), poor differentiation, perineural or lymphovascular invasion, location on ear/lip, and patient immunosuppression.
Question 6: What is the most common site of origin for lentigo maligna melanoma?
- Sun-damaged skin of the head and neck in elderly patients (Correct answer)
- Acral surfaces of hands and feet
- Mucosal surfaces
- Posterior trunk
Correct answer: Sun-damaged skin of the head and neck in elderly patients
Lentigo maligna melanoma develops from lentigo maligna (melanoma in situ) on chronically sun-damaged skin, most commonly on the face of elderly individuals.
Dermatologist Certificate Skin Cancer Pathology and Oncology 2
Merkel cell carcinoma is a neuroendocrine tumor associated with which viral pathogen?