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Retired NBME 24 Answers

nbme24/Block 2/Question#25 (reveal difficulty score)
A 35-year-old African American man comes to ...
Palms ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: derm repeat

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submitted by โˆ—lsmarshall(465)
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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.

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sad interesting fact, this is what Bob Marley died from

+15/- jgraham3(30)

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 +5  upvote downvote
submitted by blahblahblah(5)
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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).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2671032/

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submitted by โˆ—famylife(110)
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For more explanations and pictures: https://www.aimatmelanoma.org/melanoma-risk-factors/melanoma-in-people-of-color/acral-lentiginous-melanoma-alm/

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submitted by โˆ—boostcap23(42)
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I knew about acral lentigious melanoma in African American's but because I learned that it has nothing to do with UV exposure I didn't pick it and went with forehead.. Why did they talk about how he goes on a boat every weekend and doesn't use sunscreen if they just wanted us to know that African American = Acral Lentigious :( maybe I'm just dumb

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mamast16  did the same, maybe we're both dumb :( +1
tobias  we all dumb, fam! +1
xmen  no you re not, me also i did the same and it was a distractor. So we have simply to be carefull +


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 +1  upvote downvote
submitted by โˆ—nerdstewiegriffin(45)
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Acral Lentigious is NOT associated with UV exposure. So there might be another reason

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nerdstewiegriffin  Source Pathoma 2017 +
hungrybox  question doesn't have anything to do with UV exposure +1
nerdstewiegriffin  I am trying to say palms have less melanin is a wrong concept to apply. Acral Lentigious arises in dark skinned individuals and they are not related to UV exposure. I agree using melanin logic you are able to answer this Q but this logic is incorrect. and you might be aware wrong concepts don't go far. +5
greentea733  Yeah you just need to know acral lentiginous melanoma most commonly appears in African American/Asian patients. Unfortunately the question leads to to think about UV and kinda melanin, which doesn't have anything to do with what they are actually testing +


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submitted by โˆ—freemanpeng(7)
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But i was thinking back and chest are protected by clothese and Scalp protected by hat or hair and Palm not much exposed. So I chose forehead.

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submitted by โˆ—namesthegame22(13)
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Acral lentiginous melanoma is a subtype of melanoma, that occurs on the distal extremities (ie, acral sites). Its development is not associated with UV radiation, and it is the most common subtype of melanoma in individuals with darker skin (AA).

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submitted by โˆ—am4140(8)
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From reading all these comments, my new understanding is you just have to pick acral lentiginous melanoma in dark-skinned patients because the melanin in dark skin protects from the regular UV-exposure related melanoma.

So since they donโ€™t get the regular sun exposure melanoma often, this is whatโ€™s left over. Acral lentiginous melanoma is also possible in light skinned people, but light skinned people are vulnerable to sun exposure, so are more likely to get UV-exposure related melanoma.

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submitted by โˆ—linwanrun1357(17)
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I just think plams are not protected by the melanin and got this right.

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hungrybox  useless +9


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