Check out today’s Step 1 Qmax Question Challenge.
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A 60-year-old white man presents to his primary care physician for an annual examination. He has a history of hypertension that is controlled with diet and medication. He has felt well. He has, however, noticed for the past 10 months a nonresolving small bump on his scalp that occasionally bleeds when he scratches it. He is a banker and does not spend much time outdoors, but had frequent sunburns as a boy. Examination reveals a 0.6-cm flesh-colored papule with telangiectatic vessels, a rolled edge, and slight central crusting located on his scalp (see image).
Which of the following is the expected progression of this lesion?
A. An initial radial growth phase that is followed by a vertical growth phase; prognosis is significantly related to depth of the lesion at time of excision
B. Good prognosis if excised early, but a propensity for lymphatogenous metastasis mandates frequent follow-up after excision
C. Occurs exclusively within the epidermis and has no malignant potential
D. Slow growth with destruction of local tissue that may extend along nerves to penetrate into the central nervous system
E. Will remain stable for an indefinite period, and is likely to regress with residual scarring if untreated
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