Skin Signs OF Internal Malignancy — Written Clinical Reasoning · Phys Written Answers

Prompt

DCE-style written reasoning for Skin Signs OF Internal Malignancy.

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Skin Signs OF Internal Malignancy and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Alsheyyab J, Al-Mahasneh HA, Al-Khalaileh SY, Hasan HA, et al. Pancreatic Adenocarcinoma Presented as Paraneoplastic Dermatomyositis Complicated with Rhabdomyolysis: Case Report and Review Am J Case Rep, 2026.PMID 42397795
[2]Sadam Zeb M, Mian UU, Khan K, Gulalay A, et al. Hidden in Plain Sight: Systemic Mastocytosis Manifesting as Isolated Hepatosplenomegaly in the Absence of Cutaneous and Classical Manifestations-A Case Report and Literature Review Clin Case Rep, 2026.PMID 42368359
[3]Raguraman V, Mysinger M, Verma M, Mohiyuddin S, et al. Targeting Bruton tyrosine kinase with acalabrutinib attenuates murine sclerodermatous chronic graft versus host disease Front Immunol, 2026.PMID 42367798
[4]Expert Panel on Systemic Oncology, Mejias C, Morgan RL, Arora SS, et al. ACR Appropriateness Criteria® Staging and Follow-Up of Melanoma J Am Coll Radiol, 2026.PMID 41823939
[5]Takai T, Kadono T, Fujimoto N, Yoden E, et al. Japanese Dermatological Association Guidelines: Clinical Questions of Guidelines for Cutaneous Squamous Cell Carcinoma 2025 J Dermatol, 2026.PMID 41368724
[6]van de Berg DJ, Vriens MR, van Santen HM, Seur A, et al. Core Outcome Set of the Surgical Treatment of Differentiated Thyroid Carcinoma: International Consensus by Delphi Study Thyroid, 2025.PMID 41203254
[7]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
[8]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Skin Signs OF Internal Malignancy and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Alsheyyab J, Al-Mahasneh HA, Al-Khalaileh SY, Hasan HA, et al. Pancreatic Adenocarcinoma Presented as Paraneoplastic Dermatomyositis Complicated with Rhabdomyolysis: Case Report and Review Am J Case Rep, 2026.PMID 42397795
[2]Sadam Zeb M, Mian UU, Khan K, Gulalay A, et al. Hidden in Plain Sight: Systemic Mastocytosis Manifesting as Isolated Hepatosplenomegaly in the Absence of Cutaneous and Classical Manifestations-A Case Report and Literature Review Clin Case Rep, 2026.PMID 42368359
[3]Raguraman V, Mysinger M, Verma M, Mohiyuddin S, et al. Targeting Bruton tyrosine kinase with acalabrutinib attenuates murine sclerodermatous chronic graft versus host disease Front Immunol, 2026.PMID 42367798
[4]Expert Panel on Systemic Oncology, Mejias C, Morgan RL, Arora SS, et al. ACR Appropriateness Criteria® Staging and Follow-Up of Melanoma J Am Coll Radiol, 2026.PMID 41823939
[5]Takai T, Kadono T, Fujimoto N, Yoden E, et al. Japanese Dermatological Association Guidelines: Clinical Questions of Guidelines for Cutaneous Squamous Cell Carcinoma 2025 J Dermatol, 2026.PMID 41368724
[6]van de Berg DJ, Vriens MR, van Santen HM, Seur A, et al. Core Outcome Set of the Surgical Treatment of Differentiated Thyroid Carcinoma: International Consensus by Delphi Study Thyroid, 2025.PMID 41203254
[7]Xi Y, Yao T, Zhang C, Zhuang T Effectiveness of safety care and clinical nursing pathway in patients undergoing cardiovascular intervention: a randomized controlled trial Perioper Med (Lond), 2026.PMID 42469924
[8]Marks FJ, Walters SJ, Sutton L, Jacques RM What statistical methods are more appropriate for predicting recruitment at the design stage of a randomised controlled trial? Trials, 2026.PMID 42469922