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IQ Challenge

Learn and review a variety of critical dermatological diagnosis factors, treatment options, and effective protocols and practices through our interactive challenge quizzes.

  1. According to the AJCC 8th edition Melanoma Staging System, primary melanoma thickness is measured to the nearest:

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    Answer: A

    Explanation: According to the AJCC 8th edition, primary melanoma tumor thickness is to be measured to the nearest 0.1 mm, not to the nearest 0.01 as specified in prior editions.

    For more information, please see Gershenwald, Jeffrey E., et al. "Melanoma staging: Evidenceā€based changes in the American Joint Committee on Cancer eighth edition cancer staging manual." CA: a cancer journal for clinicians 67.6 (2017): 472-492

  2. Which of the following is a method for risk stratification in melanoma:

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    Answer: D

    Explanation: According to current guidelines, tumor thickness (as determined by the AJCC criteria) and SNLB are the standards in melanoma risk stratification. In addition, gene expression profiling can provide prognostic information that can aid standard clinical and pathological staging

    For more information, please see, Gershenwald, Jeffrey E., et al. "Melanoma staging: Evidence‐based changes in the American Joint Committee on Cancer eighth edition cancer staging manual." CA: a cancer journal for clinicians 67.6 (2017): 472-492

  3. Wide excision, SLN biopsy, and systemic therapy are all possible treatments for in situ melanoma.

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    Answer: B

    Explanation: According to the NCCN guidelines, wide excision is recommended for in situ melanomas; SLN biopsy is recommended for local melanoma, and systemic therapy is recommended in later stages or metastatic melanoma.

    For more information, please see, Coit, Daniel G., et al. "Melanoma, version 2.2016, NCCN clinical practice guidelines in oncology." Journal of the National Comprehensive Cancer Network 14.4 (2016): 450-473

  4. Immunotherapy for metastatic melanoma is associated with which of the following dermatological adverse event:

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    Answer: D

    Explanation: According to the latest consensus statement on the adverse events of cancer immunotherapy, immune-checkpoint therapy can have serious immediate dermatologic adverse events, including (but not limited to) dermatitis, bullous dermatoses, and vitiligo

    For more information, please see, Brahmer, Julie R., et al. "Management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy: American Society of Clinical Oncology Clinical Practice Guideline." Journal of Clinical Oncology36.17 (2018): 1714-1768.

  5. A 16-year old patient with thin pigmented lesions that are clinically suspicious of primary cutaneous melanoma presents in your office. The pathology report comes back as negative, but the patient has a family history of melanoma and you are still suspicious. What should you do next?

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    Answer: B

    Explanation: In patients with early melanoma or when melanoma is suspected, studies have shown that using gene expression assays is an efficacious method for non-invasive risk stratification. As such, before offering further imaging or SNLB testing, a non-invasive test can help in deciding which patients are appropriate candidates for further diagnostic or prognostic standard of care testing.

    For more information, please see, le Roux, Carel, et al. Zager, Jonathan S., et al. "Performance of a prognostic 31-gene expression profile in an independent cohort of 523 cutaneous melanoma patients." BMC cancer 18.1 (2018): 130.

  1. The main difference between melanoma and non-melanoma skin cancer is the cell in which the skin cancer originates. In melanoma, the metastasizing cells originate in the melanocytes. True or false?

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    Answer: B

    Explanation: true melanoma originates in melanocytes. The three main types of skin cells include; melanocytes, basal cells, and squamous cells. Different treatment plans are often required for unique types of skin cancer.

    Reference: https://www.cancer.org/cancer/melanoma-skin-cancer/about/what-is-melanoma.html

  2. Risk factors that may increase your chances of melanoma include:

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    Answer: D

    Explanation: According to the Mayo Clinic all three of the above factors increase one’s risk of contracting melanoma. Living closer to the equator exposes inhabitants to more direct UV rays while living at higher elevation exposes you to higher quantities of UV radiation. The Mayo clinic also states that decreased melanin, and as a result fairer skin, results in diminished protection from the sun and as a result a higher chance of contracting melanoma.

    Reference: https://www.mayoclinic.org/diseases-conditions/melanoma/symptoms-causes/syc-20374884

  3. The most common form of skin cancer is _____

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    Answer: B

    Explanation: According to the American Academy of Dermatology basal cell carcinoma is the most common form of skin cancer, while melanoma is the most lethal.

    Reference: https://www.aad.org/public/spot-skin-cancer/learn-about-skin-cancer/types-of-skin-cancer

  4. According to the Skin Cancer Foundation, more people are diagnosed with skin cancer annually, in the United States, than all other cancers combined. True or False?

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    Answer: A

    Explanation: The Skin Cancer Foundation reports that more people in the United States are diagnosed with skin cancer than any other cancer combined. Moreover, the Skin Cancer Foundation reports, “more than 9,500 people in the U.S. are diagnosed with skin cancer every day.”

    Reference: https://www.skincancer.org/skin-cancer-information/skin-cancer-facts/

  5. Treatment of stage II melanoma often requires:

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    Answer: D

    Explanation: According to the American Cancer Society standard treatment of stage II melanoma requires a wide excision to surgically remove the melanocytic cells followed by a lymph node biopsy. In the event that the biopsy shows metastasizing cells in surrounding lymph nodes additional immunotherapy may be necessary.

    Reference: https://www.cancer.org/cancer/melanoma-skin-cancer/treating/by-stage.html

  6. Treatment of stage IV melanoma often requires a combination of surgery, radiation, and immunotherapy. According to the American Cancer Society which immunotherapy option is proven to act as CTLA-4 inhibitor, and ultimately increase the patient's immune response to melanoma cells?

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    Answer: C

    Explanation: All of the above are immunotherapy options available for treating stage IV melanoma but Pembrolizumab and Nivolumab are PD-1 inhibitors while Ipilimumab is the only CTLA-4 inhibitor. More information on the aforementioned immunotherapy options can be found on the website below.

    Reference: https://www.cancer.org/cancer/melanoma-skin-cancer/treating/immunotherapy.html

  1. Botulinum toxin injections are a common treatment option for those suffering from hyperhidrosis. Roughly _____ people suffer from hyperhidrosis around the world.

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    Answer: C

    Explanation: According to the International Hyperhidrosis Society over 365 million people suffer from hyperhidrosis, estimating nearly 5% of the population. A common treatment plan for those suffering from hyperhidrosis is Botulinum toxin A, commonly referred to as Botox.

    Reference: https://www.sweathelp.org/

  2. Botox is an effective treatment plan for hyperhidrosis because it blocks the release of ____

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    Answer: A

    Explanation: The sympathetic nervous system, commonly referred to as the fight or flight nervous system, releases neurotransmitter acetylcholine to stimulate the surrounding sweat glands. Botulinum toxin A injections inhibit the release of acetylcholine, ultimately decreasing sweat production. According to a study on hyperhidrosis and botulinum toxin A produced by The New England Journal of Medicine, “at baseline, the mean (±SD) rate of sweat production was 192±136 mg per minute. Two weeks after the first injections the mean rate of sweat production in the axilla that received botulinum toxin A was 24±27 mg per minute, as compared with 144±113 mg per minute in the axilla that received placebo (P<0.001).” Full details on this clinical trial can be found on the website below.

    Reference: https://www.nejm.org/doi/full/10.1056/NEJM200102153440704

  3. Botox injections for the treatment of hyperhidrosis often last on average _____

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    Answer: C

    Explanation: Botox injections do not reverse hyperhidrosis but rather mask the symptoms and prevent excessive sweating for an average of 4-12 months. The exact length of time varies from patient to patient. According to the International Hyperhidrosis Society, “botox has been shown to result in an 82-87% decrease in sweating. Results start to be noticeable approximately 2 to 4 days after treatment with the full effects usually noted within 2 weeks. Dryness typically lasts 4 to 12 months”.

    Reference: https://www.sweathelp.org/hyperhidrosis-treatments/botox.html

  4. Alternative therapies that have been proven to treat hyperhidrosis include_____

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    Answer: D

    Explanation: According to the Mayo Clinic all of the above have been shown to decrease hyperhidrosis. Some antidepressants both work to decrease sweating and to decrease anxiety that may be triggered additional perspiration. Oral nerve blocking medications, specifically anticholinergics, parallel the mechanism of botox: they prevent acetylcholine from triggering sweat glands. Microwave therapy provides a more permanent treatment option as they physically destroy the sweat glands. In depth descriptions of each can be found on the following website.

    Reference: https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/diagnosis-treatment/drc-20367173

  5. Typical side effects of anticholinergics include:

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    Answer: D

    Explanation: According to the International Hyperhidrosis Society oral anticholinergic medications work systemically and decrease sweating in all areas of the body. As a result this inhibits the body’s natural cooling system and can lead to overheating1. The Mayo Clinic also reports, “possible side effects [for nerve blocking medications] include dry mouth, blurred vision and bladder problems”2

    Reference:

    1. https://www.sweathelp.org/hyperhidrosis-treatments/medications.html
    2. https://www.mayoclinic.org/diseases-conditions/hyperhidrosis/diagnosis-treatment/drc-20367173
  1. Which of the following are correct subcategories of alopecia?

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    Answer: D

    Explanation: All of the above are subcategories of alopecia. Alopecia areata is the loss of hair in patches, alopecia totalis implies loss of all hair on the scalp, and alopecia universalis denotes loss of all hair on one’s body.

    Reference: https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata

  2. Alopecia areata is an autoimmune disease which currently lacks FDA approved preventative treatment options.

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    Answer: A

    Explanation: True, Alopecia areata is an autoimmune disease that results in the loss of hair in patches from one’s scalp. According to the American Academy of Dermatology there are currently no FDA approved treatment plans to prevent alopecia but there are multiple treatment plans available to accelerate hair regrowth.

    Reference: https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata#treatment

  3. Currently treatment plans to increase hair regrowth for patients suffering from alopecia include:

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    Answer: E

    Explanation: According to the American Academy of Dermatology all four of the aforementioned treatments can all be prescribed, either alone or coupled with another prescription, to advance hair growth. Descriptions of their respective mechanisms can be found at the website below.

    Reference: https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata#treatment

  4. Patients affected with alopecia have shown higher risks for:

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    Answer: C

    Explanation: According to the AAD the presence of alopecia puts the affected individual at a higher risk for expressing symptoms of a second auto-immune disease, specifically vitiligo. In addition, NCBI reports a strong connection between alopecia and psychological disorders. According to an article posted by NCBI, The psychological impact of alopecia, “psychiatric disorders are more common in people with alopecia than in the general population, suggesting that those with alopecia may be at higher risk for developing a serious depressive episode, anxiety disorder, social phobia, or paranoid disorder”1. It has also been noted that the stress of losing one’s hair may generate said psychological symptoms including, “anxiety arising from the alopecia and the psychological impact relating to identity”2.

    Reference:

    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1261195/
    2. https://www.aad.org/public/diseases/hair-and-scalp-problems/alopecia-areata#causes
  5. Recent studies have shown Janus Kinase inhibitors to be effective in treating moderate to severe alopecia.

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    Answer: A

    Explanation: Both the NCBI and National Alopecia Areta Foundation have published research backing the efficacy of JAK inhibitors in the treatment of moderate to severe alopecia, specifically with ruxolitinib. According to NCBI, “both tofacitinib and ruxolitinib induced remarkable hair regrowth, with a mean change in SALT score of 93.8 ± 3.25 in the ruxolitinib group and 95.2 ± 2.69 in the tofacitinib group”1. The National Alopecia Areta Foundation reports, “Seventy-five percent of patients with moderate to severe alopecia areata had significant hair regrowth after treatment with ruxolitinib”2. Further details of both studies can be found on the respective websites linked below.

    Reference:

    1. https://www.ncbi.nlm.nih.gov/pubmed/30566941
    2. https://www.naaf.org/news-room/jak-inhibitors