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NBME 17 Answers

nbme17/Block 1/Question#21 (reveal difficulty score)
A 42-year-old farmer has a 7-mm red scaly ...
Actinic keratosis 🔍 / 📺 / 🌳 / 📖

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 +21  upvote downvote
submitted by cassdawg(1779)

Just to add to the explanation here is what you would see in the others (most on FA2020 p484)

  • Basal cell carcinoma:
  • Keratoacanthoma:
    • Resembles squamous cell carcinoma in that it is a rapidly growing dome shaped nodule with a keratin filled center
    • On histology it basically presents as a crater filled with keratin
  • Malignant melanoma:
    • Bad boi, look for the ABCDEs (asymmetry, border irregularity, color variation, diameter >6mm, and evolution)
    • On histology you see melanocyte proliferation below the basement membrane and it just looks uglier
  • Merkel cell carcinoma:
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kstebbins  ^Amazing with the links. Thank you! +4
victorlt14  “Actinic Keratosis Dermatopathology: Large bright-staining keratinocytes, with mild-to-moderate pleomorphism in the basal layer extending into follicles, atypical (dyskeratotic) keratinocytes, and parakeratosis” From Flitzpatrick's atlas of dermatology +1

 +8  upvote downvote
submitted by osler_weber_rendu(160)

What you can see is

1.Hyperkeratosis (thickened stratum corneum) 2.Parakeratosis (you can see the nuclei very clearly in the stratum corneum) 3.Dysplasia (notice keratinocytes hyperchromatic and large nuclei go up almost all the way to the top. This isnt so in normal skin)

all this fits actinic keratosis

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cassdawg  Actinic keratosis is FA2020 p482 if anyone needs it! +5
baja_blast  FA2019 p. 472 +3
cheesetouch  Sweet name @osler_weber_rendu #represent #cureHHT +1

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