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pruritus

Practice targeted AMC-style multiple-choice questions on pruritus.

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dermatologybreast cancerelderly patientoncologyskin lesionrashskin biopsybiopsyitchymiddle-aged woman

A 45-year-old woman presents with a 3-month history of an intensely itchy rash on her wrists and ankles. On examination, you note violaceous, flat-topped papules. What is the most likely diagnosis?

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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino — CC BY-SA 2.0 · Source

A 68-year-old woman presents with a persistent, pruritic rash on her chest wall at the site of a previous mastectomy performed 8 years ago for invasive ductal carcinoma. She completed adjuvant chemotherapy and radiation. Examination reveals the area shown. What is the MOST appropriate next step in management?

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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino — CC BY-SA 2.0 · Source

A 70-year-old woman, post-mastectomy, presents with a chronic, pruritic lesion. What is the MOST likely underlying pathophysiology?

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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino — CC BY-SA 2.0 · Source

A 68-year-old woman presents to her GP with a 3-month history of a persistent, mildly pruritic skin lesion on her left chest wall. She had a left simple mastectomy for invasive ductal carcinoma 10 years ago, followed by adjuvant therapy. She denies fever, weight loss, or other systemic symptoms. Physical examination reveals the appearance shown. What is the most appropriate initial diagnostic investigation?

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Clinical aspects of mammary Paget's disease occurred on the thoracic wall where simple mastectomy was performed some years before.
Image by Monica Giovannini, Carmelo D'Atri, Quirino Piubello, Annamaria Molino — CC BY-SA 2.0 · Source

A 68-year-old woman presents to her general practitioner with a persistent, pruritic rash on her chest wall. She reports a history of left mastectomy for invasive ductal carcinoma 8 years ago, followed by adjuvant chemotherapy and radiation therapy. She denies any recent trauma or changes in soaps or detergents. Physical examination reveals the findings shown. A punch biopsy is performed. Which of the following immunohistochemical stains would most likely be positive in this patient's biopsy sample, supporting the suspected diagnosis?

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