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NBME 17 Answers

nbme17/Block 1/Question#21 (9.8 difficulty score)
A 42-year-old farmer has a 7-mm red scaly ...
Actinic keratosis🔍

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submitted by cassdawg(580),

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:
kstebbins  ^Amazing with the links. Thank you! +2  

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

cassdawg  Actinic keratosis is FA2020 p482 if anyone needs it! +4  
baja_blast  FA2019 p. 472 +1