Skin tumours: extramammary Paget disease: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Skin tumours: extramammary Paget disease

Sample item

A 68-year-old man has a chronic, well-demarcated, red scaly weeping patch on the scrotum unresponsive to antifungals and steroids for a year. Biopsy shows large pale cells with abundant cytoplasm in the epidermis that stain for CK7. What else should be done?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Search for underlying genitourinary or anorectal adenocarcinoma

Extramammary Paget disease presents as a chronic eczematous plaque in apocrine-rich areas such as the genital and perianal regions. Paget cells are CK7 and CEA positive and mucin positive, and an associated internal adenocarcinoma is found in a proportion of cases. Wide excision or Mohs surgery is used for the skin disease.

Option by option

  • A. Perform no further investigation

    Further assessment is needed because of associated malignancy.

  • B. Search for underlying genitourinary or anorectal adenocarcinoma (correct)

    Correct. An underlying adenocarcinoma should be sought.

  • C. Prescribe long-term oral antifungals

    Antifungals do not treat Paget cells.

  • D. Treat as scabies

    Scabies is not consistent with the biopsy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is B, Search for underlying genitourinary or anorectal adenocarcinoma. Extramammary Paget disease presents as a chronic eczematous plaque in apocrine-rich areas such as the genital and perianal regions.

Why is "Perform no further investigation" not the answer?

Further assessment is needed because of associated malignancy.

Why is "Prescribe long-term oral antifungals" not the answer?

Antifungals do not treat Paget cells.

Why is "Treat as scabies" not the answer?

Scabies is not consistent with the biopsy.

What concept does this question test?

It tests Skin tumours: extramammary Paget disease in Dermatology. Paget cells are CK7 and CEA positive and mucin positive, and an associated internal adenocarcinoma is found in a proportion of cases. Wide excision or Mohs surgery is used for the skin disease.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Skin tumours: extramammary Paget disease?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.