PANCE Dermatology 3 — Questions and Answers
Question 1: A 60-year-old man presents with a brown-black lesion with asymmetry, irregular border, color variegation, and diameter of 7 mm on his back. Biopsy confirms melanoma with Breslow thickness of 1.2 mm. What is the recommended surgical margin?
- 0.5 cm margin
- 1 cm margin (Correct answer)
- 2 cm margin
- 3 cm margin
Correct answer: 1 cm margin
For melanoma with Breslow thickness 1.01–2.0 mm, a 1 cm surgical margin is recommended per NCCN guidelines.
Question 2: A 35-year-old woman develops erythematous papules and pustules on her central face, persistent flushing with alcohol or spicy food, and telangiectasias. She has no comedones. What is the diagnosis?
- Acne vulgaris
- Rosacea (Correct answer)
- Perioral dermatitis
- Sebaceous hyperplasia
Correct answer: Rosacea
Rosacea presents with central facial erythema, flushing triggers, telangiectasias, and inflammatory papulopustules but notably lacks comedones.
Question 3: A 28-year-old man presents with scaly, hypopigmented macules on his trunk that become more prominent after sun exposure. KOH preparation shows 'spaghetti and meatballs' hyphae. What organism is responsible?
- Candida albicans
- Malassezia furfur (Correct answer)
- Trichophyton rubrum
- Microsporum canis
Correct answer: Malassezia furfur
Tinea versicolor is caused by Malassezia furfur, a lipophilic yeast that produces the classic 'spaghetti and meatballs' pattern on KOH prep.
Question 4: A 5-year-old child presents with fever, malaise, and diffuse flaccid bullae with superficial skin sloughing that resembles scalded skin. Nikolsky sign is positive. What is the causative organism?
- Streptococcus pyogenes exotoxin
- Staphylococcus aureus exfoliative toxin (Correct answer)
- Pseudomonas aeruginosa endotoxin
- HSV type 1
Correct answer: Staphylococcus aureus exfoliative toxin
Staphylococcal scalded skin syndrome is caused by exfoliative toxins A and B from S. aureus that cleave desmoglein-1, causing superficial skin separation.
Question 5: A 50-year-old woman presents with Wickham striae on the buccal mucosa and violaceous, flat-topped papules on the flexor wrists. The lesions are intensely pruritic. What is the first-line treatment?
- Systemic antifungals
- High-potency topical corticosteroids (Correct answer)
- Oral antihistamines alone
- Topical calcineurin inhibitors
Correct answer: High-potency topical corticosteroids
Lichen planus is treated first-line with high-potency topical corticosteroids for cutaneous lesions; mucosal disease may require intralesional or systemic steroids.
Question 6: A 22-year-old woman presents with painful genital ulcers, tender inguinal lymphadenopathy, and dysuria. PCR confirms HSV-2 primary infection. What treatment reduces future recurrence frequency?
- Topical acyclovir ointment
- Daily oral valacyclovir suppressive therapy (Correct answer)
- Single-dose oral famciclovir
- Topical cidofovir
Correct answer: Daily oral valacyclovir suppressive therapy
Daily suppressive therapy with valacyclovir (or acyclovir) reduces HSV-2 recurrences by approximately 70–80% and decreases viral shedding.
Question 7: A 75-year-old man has a rough, scaly, erythematous papule on a sun-damaged area of his face. Biopsy shows atypical keratinocytes confined to the epidermis. What is the diagnosis?
- Squamous cell carcinoma
- Actinic keratosis
- Seborrheic keratosis
- Bowen disease (Correct answer)
Correct answer: Bowen disease
Bowen disease (SCC in situ) shows full-thickness epidermal atypia without dermal invasion, distinguishing it from invasive SCC; it is treated with topical 5-FU, PDT, or excision.
PANCE Dermatology 3
A 60-year-old man presents with a brown-black lesion with asymmetry, irregular border, color variegation, and diameter of 7 mm on his back.
Biopsy confirms melanoma with Breslow thickness of 1.2 mm.
What is the recommended surgical margin?