430. A 35-year-old male presents with a 0.3-cm flat light brown 436.

436. Where are acral lentiginous malignant melanomas most

lesion on his left forearm. The lesion is excised, and microscopy commonly located?
reveals nests of round nevus cells within the lower epidermis at a. Groin and upper thighs
the dermal-epidermal junction. There is no “fusion” present of b. Head and neck
adjacent nests of nevus cells. Cytologic atypia is not present, nor c. Mucosal membranes, especially the oral cavity
d. Palms, soles, and subungual areas
are nevus cells seen in the superficial or deep dermis. What is the
e. Trunk and proximal extremities
correct diagnosis for this lesion?
a. Compound nevus
b. Dysplastic nevus 437. A 72-year-old male presents with a slowly growing,
c. Halo nevus ulcerated lesionlocated on the pinna of his right ear. The lesion is
d. Junctional nevus excised, and histologic sections reveal infiltrating groups of cells
e. Spitz nevus in the dermis. These cells have eosinophilic cytoplasm,
intercellular bridges, and intracellular keratin formation.
431. A 68-year-old female presents with a uniformly brown, What is the correct diagnosis for this lesion?
round lesion which appears to be “stuck on” the right side of her a. Basal cell carcinoma
face. Histologically, this lesion will most likely reveal b. Dermatofibrosarcoma protuberans
a. Hyperkeratosis with horn and pseudohorn cysts c. Merkel cell carcinoma
b. Hyperkeratosis with papillomatosis but no koilocytosis d. Poorly differentiated adenocarcinoma
c. Hyperkeratosis with papillomatosis and koilocytosis e. Squamous cell carcinoma
d. A cup-shaped lesion with a central keratin-filled crater
e. Atypia of epidermal keratinocytes 438. A 67-year-old male presents with a slowly growing lesion
that involves the lower portion of his left lower eyelid. You
432. A 23-year-old female presents with a 0.4-cm nodule within examine the lesion and find it to be a pearly papule with raised
the skin of the left side of her neck. The clinician removes the margins and a central ulcer (rodent ulcer). Histologic sections
lesion and sends it to the pathology lab, calling it a “sebaceous from this lesion would most likely reveal
cyst.” Histologic sections reveal a cystic structure in the dermis a. Reactive epidermal cells surrounding a central superficial ulcer
that is filled with keratin and lined by a stratified squamous b. Infiltrating groups of basaloid cells with peritumoral clefting
epithelium, which has a granular cell layer. This cyst is not c. Infiltrating groups of eosinophilic cells with keratin formation
ruptured, no adnexal structures are seen within the wall of the d. Dermal aggregates of small cells histologically similar to oat cell
cyst, and no atypia is present. What is the correct diagnosis? carcinoma
a. Acrochordon e. An in situ lesion with full-thickness epidermal atypia
b. Cystic hygroma
c. Epithelial inclusion cyst 439. A 65-year-old man presents with multiple plaquelike
d. Intradermal nevus pruritic lesions scattered over his body. These lesions do not
e. Pilar cyst respond to topical steroid therapy. A biopsy of one of the lesions
reveals a dermal infiltrate of atypicalappearing
433. Which one of the listed syndromes, seen in the clinical mononuclear cells, some of which occupy spaces within the
photograph below, poses the greatest risk for development of a epidermis. A periodic acid–Schiff (PAS) stain demonstrates areas
malignant melanoma? of PAS positive material in the cytoplasm of these cells. The
a. Basal cell nevus syndrome peripheral smear exhibits similar atypical mononuclear cells,
b. Dysplastic nevus syndrome many of which have a prominent nuclear cleft. These malignant
c. Leser-Trelat syndrome cells originated from
d. Scalded skin syndrome a. CD4-positive T cells
e. Stevens-Johnson syndrome b. CD5-positive B cells
c. CD8-positive T cells
434. A 65-year-old male farmer presents with a small, scaly d. CD16-positive natural killer cells
erythematous lesion on the helix of his left ear. A biopsy from e. CD21-positive B cells
this lesion reveals marked degeneration of the dermal collagen
(solar elastosis) along with atypia of the squamous epidermal 440. A 23-year-old female presents with a 0.4-cm firm brown
cells. The atypia, however, does not involve the full thickness of lesion on her upper right thigh. Histologic sections from this
the epidermis, and no invasion into the underlying tissue is seen. lesion reveal an irregular area in the upper dermis that is
What is the correct diagnosis for this skin lesion? composed of a mixture of fibroblasts, histiocytes, stromal cells,
a. Actinic keratosis and capillaries. The majority of cells in this mixture
b. Bowen’s disease are fibroblasts. The overlying epidermis reveals hyperplasia of
c. Keratoacanthoma the basal layers. What is the correct diagnosis?
d. Seborrheic keratosis a. Dermatofibroma
e. Squamous cell carcinoma b. Dermatofibrosarcoma protuberans
c. Fibroxanthoma
435. Which of the following pairs of disorders would most d. Pyogenic granuloma
appropriately be considered in the differential diagnosis for the e. Sclerosing hemangioma
lesion seen in the photomicrograph below?
a. Superficial spreading malignant melanoma in situ and Paget’s disease
b. Mycosis fungoides and metastatic carcinoma
c. Psoriasis and lichen planus
d. Lupus erythematosus and lupus vulgaris
e. Leukemia and lymphoma
441. A 26-year-old female presents with multiple red-brown 446. A 19-year-old male presents with a rash that involves a
macules and papules, pruritus (itching), and flushing. Physical large, irregular portion of his trunk. Examination reveals several
examination reveals that skin lesions can be produced by firm annular lesions that have a raised papulovesicular border with
rubbing. A biopsy of one of these skin lesions reveals central hypopigmentation. Examination of this area under a
perivascular collections of mononuclear cells that stain positively Wood’s lamp reveals a yellow fluorescence.
with toluidine blue. What is the correct diagnosis? A scraping of this area viewed under the microscope after KOH
a. Mycosis fungoides is added reveals characteristic “spaghetti and meatball” forms.
b. Merkel cell carcinoma What is the cause of this skin lesion?
c. Weber-Christian disease a. Malassezia furfur
d. Letterer-Siwe disease b. Molluscum contagiosum
e. Urticaria pigmentosa c. Sarcoptes scabiei
d. Staphylococcus aureus
442. Histologic examination of a skin biopsy from an adult male e. Trichophyton rubrum
reveals hyperkeratosis without parakeratosis, an increase in the
granular cell layer, acanthosis, and a bandlike lymphocytic
infiltrate in the upper dermis involving the dermal-epidermal
junction. Which one of the following describes the most likely
clinical appearance of this patient’s lesions?
a. Generalized skin eruptions with oval salmon-colored papules along flexure
lines
b. Macules, papules, and vesicles on the trunk along with several target
lesions
c. Pruritic purple papules and plaques on the flexor surfaces of the
extremities
d. Red plaques covered by silver scales on the extensor surfaces of the
elbows and knees
e. Soft yellow-orange plaques along the neck, axilla, and groin

443. A 34-year-old male presents with multiple large, sharply

defined, silver-white scaly plaques on the extensor surfaces of his
elbows and knees and on his scalp. Physical examination reveals
discoloration and pitting of his fingernails. Lifting of one of the
scales on his elbows produces multiple minute areas of bleeding
(positive Auspitz sign). Histologic sections from one of the scaly
plaques would most likely reveal
a. Subepithelial bullae
b. Regular elongation of the rete ridges
c. Liquefactive degeneration of the basal layer of the epidermis
d. Increased granular cell layer
e. Chronic inflammation below a zone of degenerated collagen

444. A 52-year-old male presents with multiple tense bullae that

involve his skin but not his oral mucosa. Physical examination
finds that none of the bullae have ruptured, and the Nikolsky
sign is negative. A biopsy from one of the skin lesions reveals
acantholytic intraepidermal bullae. No deposition
of IgA is seen with special staining techniques. What is the
correct diagnosis for this individual’s skin disorder?
a. Pemphigus vulgaris
b. Bullous pemphigoid
c. Dermatitis herpetiformis
d. Psoriasis
e. Lichen planus

445. The photomicrograph below is from a small papillary lesion

found on the dorsal surface of the left hand of a 18-year-old.
Describe the microscopic appearance of this lesion.
a. Acute necrotizing hemorrhagic vasculitis
b. Aggregates of epidermal cells with molluscum bodies
c. Dermal edema and mild superficial perivascular mixed inflammation
d. Hyperkeratosis, papillomatosis, and prominent keratohyalin granules
e. Intraepidermal vesicle, multinucleated giant cells, and Cowdry A
inclusions