Dermatology — Skin Lesions, Pigment and Hair, NMC MBBS licence examination syllabus (Nepal Medical Council).
NMC-style practice questions written for this site. They are not past questions, and no past paper has been reproduced.
A 42-year-old man reports that a mole on his back has become larger over six months and now contains both brown and black areas. It does not itch or bleed. What is the appropriate response?
Answer: Refer for specialist assessment. Growth with variation in colour within the lesion is exactly the pattern that matters. The absence of itching and bleeding is not reassuring — those are late features, and waiting for them removes the advantage of early recognition, which for melanoma is the main determinant of outcome.
A farmer has had an ulcerated, crusted lesion on the lower lip for three months despite repeated dressings. What should be considered?
Answer: Squamous cell carcinoma. A non-healing ulcer on sun-exposed skin in someone with prolonged sun exposure needs assessment rather than further dressings, and unlike a basal cell carcinoma it can spread.
A 24-year-old woman has a single pale patch on her forearm. What is the first bedside test, and how does the result change the diagnosis?
Answer: Test sensation over the patch. Loss of sensation makes leprosy the diagnosis until proven otherwise, and the nerve supplying that area should be palpated for thickening. Normal sensation with complete, sharply defined pigment loss points towards vitiligo, which is worth pairing with questions about thyroid and other autoimmune disease.
Two patients present with hair loss. One has a smooth, shiny patch of scalp with no visible follicular openings; the other has patchy loss with openings still visible. How does this change management?
Answer: Absent follicular openings indicate scarring loss — permanent in that area, and needing early referral because treatment can only protect the follicles that remain. Visible openings indicate non-scarring loss, where regrowth is possible and the useful step is looking for a cause such as iron deficiency, thyroid disease or a recent illness.
Why is a pigmented streak under a fingernail worth taking seriously?
Answer: Melanoma can arise under a nail and on the palm or sole, where it is easily mistaken for a bruise or a fungal nail. Diagnosis at these sites is more often delayed, particularly in darker skin, so a new or widening streak needs proper assessment rather than reassurance.
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