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STUDY QUESTIONS
1. Which of the following conditions is the most common reason for dermatology visits in the United States?
a. Malignant melanoma b. Basal cell carcinoma c. Actinic keratosis
d. Squamous cell carcinoma
2. Many studies have shown that excessive sun exposure is the most common cause of skin damage and development of skin cancers. Which of the following describes the pathogenesis of basal cell carcinoma?
a. Accumulative dose of chronic UV radiation exposure induces DNA damage and p53 genetic mutation.
b. Episodes of excessive UV radiation exposure, including childhood history of severe sunburn, induce genetic alteration of PTCH1 gene on chromosome 9q.
c. Excessive UV radiation exposure and genetic makeup involving the mutation of CDKN2A gene located on chromosome 9p21.
d. Excessive UV radiation exposure and genetic mutation involving CDKN2A interferes with p53 in cell cycle.
3. Assessment of an infiltrative squamous cell carcinoma includes which of the following?
a. Dome-shaped lesion with central ulceration
b. Pearly lesion with raised borders with telangiectasias on the surface c. Scaly, irregular, raised red patches occurring in actinically damaged skin d. Vague, yellowish, scar-like plaque with indistinct margins
4. Which of the following types of cutaneous malignancies grows rapidly from a small papule to a large volcano-like nodule, with a central keratotic plug, in just 2 to 6 weeks?
a. Keratoacanthoma b. Basal cell carcinoma c. Mycosis fungoides d. Actinic keratosis
5. Which two types of cutaneous malignancies highly resemble each other clinically, as well as histologically?
a. Actinic keratosis and squamous cell carcinoma b. Basal cell carcinoma and malignant melanoma
c. Mycosis fungoides and Sézary syndrome
d. Keratoacanthoma and squamous cell carcinoma
6. The American Academy of Dermatology and the American Cancer Society recommend the use of the A (asymmetry), B (border), C (color), D (diameter), and E (evolution) pneumonic to screen for which of the following types of cutaneous malignancy?
a. Kaposi sarcoma b. Malignant melanoma
c. Cutaneous T-cell lymphoma d. Keratoacanthoma
7. Which of the following describes a change in the 2010 American Joint Commission on Cancer Melanoma Staging System, 7th edition?
a. Tumor thickness is recategorized as 1, 2, and 4 mm.
b. Tumor characteristic of ulceration became an unremarkable factor.
c. In-transit metastasis is separated from satellite lesions in staging.
d. Mitotic rate (T1 mitoses/mm2) replaced Clark level of invasion as the primary criterion for staging and prognosis.
8. Mr. Jones is a 65-year-old farmer. He is at a dermatology clinic with his wife who is concerned about a changing mole on his back. He describes it as a mole that he has had all of his life, but he has been experiencing increased itchiness, frequent burning-like sensation, and occasional spontaneous bleeding at the mole for the past 6 months. His wife believes the mole has been changing from a smooth-bordered light brown mole to an ill-defined bordered, reddish brown, partially white and black mole. Which of the following is your presumptive diagnosis of this lesion?
a. Malignant melanoma b. Squamous cell carcinoma c. Basal cell carcinoma d. Kaposi sarcoma
9. Mr. Duke is a 49-year-old AIDS patient with multiple comorbidities, and his medications have been causing frequent adverse reactions. For the past 3 months, his new symptoms include firm, purplish, nontender bumps and reddish patches around his ears, jawline, and chest areas. He is at a dermatology clinic, discussing possible skin biopsy for a diagnosis. Which of the following is your presumptive diagnosis of these lesions?
a. Malignant melanoma b. Squamous cell carcinoma c. Basal cell carcinoma d. Kaposi sarcoma
10. Mrs. Smith is a 57-year-old renal transplant recipient on immunosuppressant medications. She is at a dermatology clinic reporting a new lesion on her left temple, which was first noted about 4 months ago. She describes it as a shiny, dark brown growth approximately 5 mm in diameter, and it has a semitranslucent border at the base.
Which of the following is your presumptive diagnosis of this lesion?
a. Nodular melanoma
b. Nodular squamous cell carcinoma c. Pigmented basal cell carcinoma d. Kaposi sarcoma
11. Which of the following genetic diseases is most susceptible to developing both basal cell carcinoma and squamous cell carcinoma?
a. Nevoid basal cell carcinoma syndrome b. Muir-Torre syndrome
c. Epidermolysis bullosa syndrome d. Xeroderma pigmentosum
12. Which of the following is optimal patient education for preventing melanoma and nonmelanoma skin cancers?
a. Daily use of multivitamins containing vitamin A and drinking adequate amount of water.
b. Daily physical activities during morning and evening hours only to avoid midday sun exposure.
c. Daily journal writing to count total number of moles, and seeking medical attention when a new mole lesion is noted.
d. Daily use of sunscreen, photoprotective clothing, and performing regular skin self- examination.
ANSWERS TO STUDY QUESTIONS
1.c 2.b 3.a 4.a 5.d 6.b 7.d 8.a 9.d 10.c
11.d 12.d
CHAPTER 17 Disorders of Pigmentation and Dermatologic Considerations in Ethnic Skin
Heather Onoday
OBJECTIVES
After studying this chapter, the reader will be able to:
Identify disorders of hypo- and hyperpigmentation.
Describe current treatment modalities used to treat pigment disorders including vitiligo, albinism, tuberous sclerosis, and melasma.
Differentiate different types of nevi.
List normal variations in pigmentation in people of color.
Describe skin disorders and treatment modalities of those disorders that are commonly occurring in ethnic individuals.
Identify the psychosocial impact imposed by skin diseases unique to individuals with disorders of pigmentation as well as ethnic population with skin disorders.
KEY POINTS
Pigmentation disorders, either hypo- or hyperpigmentation, can have tremendous impact on patients from both a cosmetic and a health standpoint.
Dermatology nurses must be knowledgeable of disorders of pigmentation and nevi to effectively care for patients and improve their outcomes.
Patients with hypopigmentation, hyperpigmentation, and nevi may require emotional support and education to assist with coping processes.
The U.S. Census Bureau estimates that by the year 2050, people of ethnic skin will make up almost half of the American population. These changing demographics will change health care needs.
For the purpose of this chapter, Asian, Black, and Hispanic skin types will be considered as representative of the ethnic population.
Distinguishing between normal and pathological variations in the ethnic population by
the health care team is essential to the successful management of this group of clients.
Social customs and traditional beliefs may influence adherence to treatment regimes.