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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