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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: 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

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

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

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.

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.

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

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

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

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/

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

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

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/

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

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

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

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

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

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

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

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

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

Answer: A

In a recent study of 42 children with atopic dermatitis, those who bathed twice daily for 15-20 minutes exhibited a decreased severity of atopic dermatitis, in contrast to patients who bathed twice a week. In light of these findings UpToDate currently recommends that patients bathe daily, followed immediately by application of emollients and/or prescription ointments, adhering to the treatment plans prescribed by their respective physician.

References:

1. Ofori, Abena, and Rosamaria Corona. “What's New in Dermatology.” UpToDate, 11 May 2020, www.uptodate.com/contents/whats-new-in-dermatology.

Answer: B

False, antimicrobials and antiseptics such as bleach-baths are generally reserved for patients who present with symptoms of secondary infections. Standard signs of impetiginization include crusting, weeping, and pustules. For the general population moisturizers and wet-wraps are prescribed as the first line of treatment. Similarly systemic antibiotics should be avoided in the absence of a bacterial infection.

References:

1. “Atopic Dermatitis Clinical Guideline.” American Academy of Dermatology, www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis.

Answer: C

Topical calcineurin inhibitors (TCI) inhibit proinflammatory cytokines and minimize the effects of atopic dermatitis.

References:

1. Gutfreund, Katarzyna et al. “Topical calcineurin inhibitors in dermatology. Part I: Properties, method and effectiveness of drug use.” Postepy dermatologii i alergologii vol. 30,3 (2013): 165-9. doi:10.5114/pdia.2013.35619

Answer: B

Topical antihistamines are not currently recommended for the treatment of atopic dermatitis. According to the American Academy of Dermatology, the likelihood that topical antihistamines will exacerbate atopic dermatitis and/or trigger contact dermatitis exceeds any potential benefits. Alternatively, oral sedative-antihistamines are occasionally recommended in conjunction with a larger treatment plan given their sleep aid properties, allowing patients to sleep through the night despite pruritus.

Answer: D

Widespread use of systemic steroids should be avoided. They should be narrowly used to treat severe cases of atopic dermatitis, when alternative treatment plans have been ineffective, or as a bridge between various treatment plans.

References:

1. Drucker, A M et al. “Use of systemic corticosteroids for atopic dermatitis: International Eczema Council consensus statement.” The British journal of dermatology vol. 178,3 (2018): 768-775. doi:10.1111/bjd.15928

Answer: False

According to the American Academy of Dermatology, there lacks sufficient data to support the recommendation for probiotics/prebiotics as a line of treatment against atopic dermatitis.

References:

1. “Atopic Dermatitis Clinical Guideline.” American Academy of Dermatology, www.aad.org/member/clinical-quality/guidelines/atopic-dermatitis.

Answer: D

All of the above are examples of non-permanent tissue fillers, known for their cosmetic applications.

References:

1. Carruthers, Jean, and Shannon Humphrey. “Injectable Soft Tissue Fillers: Overview of Clinical Use.” UpToDate, www.uptodate.com/contents/injectable-soft-tissue-fillers-overview-of-clinical-use.

Answer: B

False, while three of the four aforementioned fillers are permanent, collagen is an example of a biodegradable filler. Hydrogel polymers would be an appropriate fourth example of a permanent filler.

References:

1. Carruthers, Jean, and Shannon Humphrey. “Injectable Soft Tissue Fillers: Overview of Clinical Use.” UpToDate, www.uptodate.com/contents/injectable-soft-tissue-fillers-overview-of-clinical-use.

Answer: C

According to UpToDate, hyaluronic acid based fillers are currently the most commonly used soft tissue fillers. Hyaluronic acid is a naturally occurring substance found primarily within soft connective tissue and is known for its water attractive properties.

References:

1. Carruthers, Jean, and Shannon Humphrey. “Injectable Soft Tissue Fillers: Overview of Clinical Use.” UpToDate, www.uptodate.com/contents/injectable-soft-tissue-fillers-overview-of-clinical-use.
2. “Dermal Fillers: Minimally Invasive Procedures .” American Society of Plastic Surgeons, www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/types.

Answer: A

A loss of collagen between the epidermal and dermal layers results in facial wrinkles. Additionally, repeated use of the facial muscles in conjunction with lipoatrophy leads to prominent facial wrinkles.

References:

1. Newman, James. “Review of Soft Tissue Augmentation in the Face.” Clinical, Cosmetic and Investigational Dermatology, Dove Medical Press, 28 Aug. 2009, www.ncbi.nlm.nih.gov/pmc/articles/PMC3047934/.

Answer: C

Poly-L-lactic acid takes 2-3 weeks following injection for noticeable results to take effect.

References:

1. “Fillers: FAQs.” American Academy of Dermatology, www.aad.org/public/cosmetic/wrinkles/fillers-faqs.

Answer: D

Poly-L-lactic injections typically last between 1-3 years.

References:

1. “Fillers: FAQs.” American Academy of Dermatology, www.aad.org/public/cosmetic/wrinkles/fillers-faqs.

Answer: C

Poly-L-lactic injections stimulate the production of collagen thereby contributing to their gradual and lasting results.

References:

1. “Injectable Poly-l-Lactic Acid.” American Society for Dermatologic Surgery, www.asds.net/skin-experts/skin-treatments/injectables/injectable-poly-l-lactic-acid.

Answer: B

Minocycline is a tetracycline antibiotic that is often used to treat severe acne, among other bacterial infections.

References:

1. Petrou, Ilya. “Pipeline Treatments Show Promise for Acne Patients.” Dermatology Times, 22 Apr. 2020, www.dermatologytimes.com/acne/pipeline-treatments-show-promise-acne-patients.

Answer: A

Minocycline has proven effective in treating MRSA.

References:

1. Petrou, Ilya. “Pipeline Treatments Show Promise for Acne Patients.” Dermatology Times, 22 Apr. 2020, www.dermatologytimes.com/acne/pipeline-treatments-show-promise-acne-patients.

Answer: A

True, the two main classes of acne scars are hypertrophic/keloid scars and atrophic/depressed scars, aptly named for their individual appearances. Hypertrophic scars are the result of excess collagen production in response to acne while atrophic scars are indentations in the skin due to a tissue deficiency.

References:

1. “Acne Scars.” American Society for Dermatologic Surgery, www.asds.net/skin-experts/skin-conditions/acne-scars

Answer: A

True, chemical peels and microneedling are among an array of treatment options available for lessening the appearance of acne scars. Additional treatment options include microdermabrasion, laser therapy, laser resurfacing, and soft tissue fillers.

References:

1. “Acne Scars.” American Society for Dermatologic Surgery, www.asds.net/skin-experts/skin-conditions/acne-scars

Answer: C

According to the American Society for Dermatologic Surgery, 80% of the population between the ages of 11 to 30 suffers from some form of acne.

Answer: B

Glycolic or trichloroacetic acid is an example of a medium peel used to treat mild skin discoloration and smooth the appearance of skin.

References:

1. “Chemical Peels.” American Society for Dermatologic Surgery, www.asds.net/skin-experts/skin-conditions/acne-scars.