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Dermatomyositis rash — ABIM Board MCQ

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HardDermatologyDermatomyositis rashABIM Board

A 63-year-old woman has newly diagnosed dermatomyositis with dysphagia, cutaneous ulceration, and anti-TIF1-gamma antibodies. Initial age-appropriate cancer screening six months ago was normal. Which approach is most appropriate now?

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Correct answer: E — Perform enhanced malignancy screening alongside age-based cancer screening now

The best answer is “Perform enhanced malignancy screening alongside age-based cancer screening now”. Adult dermatomyositis, age over 40, anti-TIF1-gamma, dysphagia, and cutaneous ulceration each increase IIM-associated cancer risk. Multiple high-risk features warrant enhanced screening at diagnosis, not reliance on recently completed population screening alone. The excess risk is concentrated around myositis onset, and neither CK response nor the autoimmune nature of the illness excludes malignancy.

Reference: IMACS International Guideline for IIM-Associated Cancer Screening: https://pmc.ncbi.nlm.nih.gov/articles/PMC10834225/