Question 1 question paper
A 35 year old Spanish national notices a change in one of the moles on his right forearm.
Whilst in the UK he visits a GP. He describes the mole as becoming larger, darker and more
irregular in shape. The GP excises the moles and send the sample to histopathology.
a
From which respective cell types are malignant melanoma, basal cell
carcinoma and squamous cell carcinoma derived?
Max
mark
3
b
Actual
mark
What is this patient’s most likely diagnosis and what is the most important
risk factor?
Max
mark
2
c
Actual
mark
What are the 2 key factors in determining prognosis of a skin cancer?
Max
mark
2
d
Max
mark
4
Actual
mark
The histopathology report indicates that the skin lesion is 5 mm in depth,
ulcerated with “brisk” mitotic figures. Is the patient’s prognosis good or
poor? Why?
Actual
mark
e
During your consultation the patient makes repeated reference to a “rodent
ulcer.” What is this known as histopathologically?
Max
mark
1
f
Actual
mark
6 months later the patient develops metastatic disease that spreads to the
brain and lung. What are the cellular and tissue events that must occur for
successful metastasis to happen?
Max
mark
6
g
Max
mark
2
Actual
mark
Name 2 routes by which this cancer may have spread.
Actual
mark
Question 1 answers
A 30 year old Spanish national notices a change in one of the moles on his right forearm.
Whilst in the UK he visits a GP. He describes the mole as becoming larger, darker and more
irregular in shape. The GP excises the moles and send the sample to histopathology.
a
From which respective cell types are malignant melanoma, basal cell
carcinoma and squamous cell carcinoma derived?
Melanocytes;
basal cells;
squamous cells of the skin
Max
mark
3
b
Actual
mark
What is this patient’s most likely diagnosis and what is the most important
risk factor?
Malignant melanoma caused by excessive exposure to ultraviolet light
Max
mark
2
c
Actual
mark
What are the 2 key factors in determining prognosis of a skin cancer?
Stage and grade
Max
mark
2
d
Max
mark
4
Actual
mark
The histopathology report indicates that the skin lesion is 5 mm in depth,
ulcerated with “brisk” mitotic figures. Is the patient’s prognosis good or
poor? Why?
Poor
5mm is deep for this kind of skin lesion.
Ulceration and irregular edge are signs of poor prognosis
“Brisk” means numerous mitotic figures (indicator or malignancy)
Actual
mark
e
During your consultation the patient makes repeated reference to a “rodent
ulcer.” What is this known as histopathologically?
Basal cell carcinoma
Max
mark
1
f
Max
mark
6
g
Max
mark
2
Actual
mark
6 months later the patient develops metastatic disease that spreads to the
brain and lung. What are the cellular and tissue events that must occur for
successful metastasis to happen?
Invasion of the basement membrane
Passage through the ECM
Intravasation (invasion into blood vessels)
Immune interaction (avoidance of immune mediated destruction)
Platelet adhesion
Adhesion to endothelium
Extravasation
Angiogenesis
6 out of 8 are allowed. Must be in correct order!
Actual
mark
Name 2 routes by which this cancer may have spread.
Vascular
Lymphatics
Transcoelomic spaces
Direct spread
Allows any 2 of 4
Actual
mark