Exam 2: Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease

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Question 3: How would you describe the risk of colorectal cancer to a patient diagnosed with ulcerative colitis before age 20?

a. The risk is the same as for individuals of comparable age in the general population. b. The risk is the same as for individuals diagnosed with ulcerative colitis in their 30s and 40s. c. The risk is the same as for individuals diagnosed with ulcerative colitis in their 40s and 50s. d. The risk is higher than among individuals of comparable age in the general population but low in terms of absolute risk. e. The risk is high both relative to individuals of comparable age in the general population and in terms of absolute risk.

Question 4: Primary sclerosing cholangitis is most strongly associated with:

a. Left-sided colorectal cancer among patients with Crohn’s disease. b. Right-sided colorectal cancer among patients with Crohn’s disease. c. Left-sided colorectal cancer among patients with ulcerative colitis. d. Right-sided colorectal cancer among patients with ulcerative colitis. e. Right-sided colorectal cancer independent of concomitant inflammatory bowel disease.

Exam 2: Risk of Melanoma and Nonmelanoma Skin Cancer Among Patients With Inflammatory Bowel Disease Contact hours: 1.0 Expiration Date: August 31, 2013 Test ID No.: gastro00167

Question 1: Which of the following classes of medical therapies is associated with increased melanoma risk in patients with inflammatory bowel disease (IBD)?

a. b. c. d. e.

Mesalamine. Thiopurines. Biologic anti-tumor necrosis factor (TNF). Methotrexate. All of the above.

a. b. c. d. e.

Mesalamine. Thiopurines. Biologic anti-TNF. Thiopurine ⫹ biologic anti-TNF. None of the above.

Question 2: Which of the following classes or combinations of medical therapies is most strongly associated with increased nonmelanoma skin cancer (NMSC) risk in patients with IBD?

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Question 3: A 37-year-old man with newly diagnosed small bowel Crohn’s disease presents in follow-up. He has been unable to taper off of prednisone owing to increased symptoms with doses of ⬍15 mg/d. You discuss initiation of an anti-TNF agent and immunomodulator. Which of the following statements is correct with regard to counseling on the risks of skin cancer in patients with IBD on immunosuppressive therapies?

a. The absolute risks of melanoma and NMSC in patients with IBD are similar at ⬎900/100,000 person-years. b. NMSC risk increases with increasing duration of thiopurine use. c. Thiopurine use increases the risk of melanoma. d. The risk of melanoma is 4-fold higher with anti-TNF biologic use. e. The excess risk of NMSC owing to thiopurine use resolves with discontinuation of the medication.

Question 4: Which of the following is not an example of skin cancer primary prevention within the IBD population?

a. Broad-spectrum sunscreen use (sun protection factor [SPF] of ⱖ30). b. Sun protective clothing (universal protection factor [UPF] of ⱖ30). c. Routine skin screening by a dermatologist. d. Sun avoidance. e. Avoidance of tanning beds.