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DM Holster Sign — SCE Dermatology MCQ

Instant feedback + full explanation. One question, done properly.

HardConnective Tissue & VasculitisDM Holster SignSCE Dermatology

A 67-year-old man develops rapidly progressive dermatomyositis with dysphagia, cutaneous necrosis and anti-TIF1-gamma antibodies. Initial examination has not identified a tumour. Which implication should drive the next assessment?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Treat him as having increased malignancy risk and arrange risk-directed cancer screening

Explanation lettering: D = shown as A · E = shown as B · B = shown as D · A = shown as E

E is correct. BSR advises considering cancer risk in every adult with inflammatory myopathy, with particular concern in older-onset disease, male sex, dysphagia, cutaneous necrosis, rapid onset, treatment resistance and anti-TIF1-gamma positivity. This patient has several of those features, so a normal initial examination does not end the assessment; age-appropriate and risk-directed imaging and investigations should be coordinated with the relevant specialists. Anti-TIF1-gamma is not an antisynthetase antibody, the distribution of a rash does not localise an occult cancer, and juvenile-onset rules do not apply. The exact screening strategy should reflect symptoms, sex, age and local myositis pathways.

Reference: BSR guideline on idiopathic inflammatory myopathy: https://academic.oup.com/rheumatology/article/61/5/1760/6555980