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NBME 24 Answers

nbme24/Block 2/Question#25

A 35-year-old African American man comes to the ...


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submitted by lsmarshall(262),

Acral lentigious is most common type of melanoma in African Americans and is on the palms or soels. I guess the typical thinking of chest and back (sun exposed) is a little different in this type? Among all demographics; melanomas occur the majority of time on the limbs (~36% lower and ~19% upper); trunk is ~27%... So based on that and him being of African descent we can choose palms.

Melanin in darkly pigmented skin can provide an SPF (sun protective factor) of 1.5 - 4. Amount of UV light getting through is 1/SPF, so a SPF of 4 reduces UV radiation by 75%. So the areas without this protective feature are most at risk (palms/soles).


Acral Lentigious is NOT associated with UV exposure. So there might be another reason

nerdstewiegriffin  Source Pathoma 2017 +  

I just think plams are not protected by the melanin and got this right.