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Chapter 21: Pathology of the Skin

In general, which of the below type of skin cancer has the worst prognosis (potential for mortality)?

A. Melanoma

B. Merkel cell carcinoma

C. Squamous cell carcinoma

D. Basal cell carcinoma

E. Dermatofibrosarcoma protuberans

Answer: B

Explanation: Merkel cell carcinoma is the form of skin cancer with the greatest risk for mortality, even greater than melanoma. Basal cell carcinoma tends to grow locally, but rarely if ever metastasis. Squamous cell carcinoma in general has a good prognosis when treated early, although metastasis and mortality are possible, especially in high risk patients (such as patients who have undergone an organ transplant or are otherwise immunosuppressed). Dermatofibrosarcoma protuberans is considered to be of low to intermediate metastatic potential, with recurrences being common but metastases less so.

The histological features most strongly related to prognosis in melanoma include:

A. Tumor thickness, growth pattern, presence/absence of an associated nevus

B. Growth pattern, presence/absence of nucleoli, presence/absence of an associated nevus

C. Tumor thickness, mitotic rate, presence/absence of ulceration

D. Presence/absence of associated nevus, degree of cytological variability, presence/absence of regression

E. Presence/abscess of regression, mitotic rate, presence/absence of ulceration

Answer: C

Explanation: The strongest prognostic indicator is tumor thickness (depth of invasion as measured from the top of the granular layer). Both mitotic rate and presence/absence of ulceration are prognostic factors, however, currently only presence/absence of ulceration is included in the most recent (2018) American Joint Committee on Cancer tumor staging parameters.

Kaposi sarcoma has been associated with which viral infection?

A. CMV

B. HPV

C. HSV-2

D. HHV-8

E. Polyomavirus

Answer: D

Explanation: Kaposi sarcoma, most commonly seen in the setting of HIV infection in the United States, has been strongly associated with HHV-8 infection. Cutaneous CMV infection can also be seen in the context of immunosuppression, and most characteristically manifests as cutaneous ulcers. Furthermore, both CMV and HSV-2 have been implicated in congenital infections, known as “TORCH” infections (beyond the scope of this chapter). HPV infections cause viral warts. HSV-2 is the classic viral etiology of genital herpes infection. Finally, a type ...

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