Part A

In this part of the test, you’ll read four short texts related to a single healthcare topic. In the actual OET Reading test you have 15 minutes to do Part A. Try to complete this section within 15 minutes.

• Click to read each of the four texts A–D.
• For each question 1–20, look through the texts A–D to find the relevant
• Your answers should only be taken from texts A–D and should be correctly spelled

Text A

Melanoma accounts for less than 5% of all skin cancers, however, it causes the greatest number of skin-cancer–related deaths worldwide.

Perhaps the most helpful clinical feature of melanoma is that biologically significant melanomas change, regardless of their other clinical features. If these changes have been accurately perceived by the patient this may be very helpful in determining the right index of suspicion. In the radial growth phase, melanomas alter in size, shape or colour, whereas in the vertical growth phase melanomas have altered elevation, ulceration, and may bleed. The minimum requirement for the assessment of any potential skin cancer is a history of the duration of a lesion and any change within it.

Risk factors for developing malignant melanoma include a past history of primary invasive melanoma, naevi (more than 100 common naevi or more than two atypical naevi carries a 5-to-20- fold increased risk of melanoma), and sun exposure (especially acute exposure and severe sunburn in childhood). In addition, a family history of melanoma as well as certain skin pigmentation, e.g. pale Caucasian skin (type 1 or 2), fair skin with a poor ability to tan, or a freckled complexion with or without red or blond hair, results in double a person’s risk of melanoma.

Text B

As well as having distinct histopathology, melanoma subtypes differ in their clinical presentation.

Superficial spreading melanoma

This accounts for nearly 70% of cutaneous melanoma and is the most common subtype in white individuals aged 30–50 years, as well as those with clinical atypical/dysplastic nevi it is most common on the trunk in both men and women, and on the legs in women.

Acral lentiginous melanoma

This is the least common subtype of melanoma in white-skinned people (2–8% of melanoma cases) but is the most common subtype of melanoma in dark-skinned individuals, i.e. African American, Asian, and Hispanic, representing 29–72% of melanoma cases and, because of delays in diagnosis, may be associated with a worse prognosis. Acral lentiginous melanoma occurs on the palms, on the soles, or beneath the nail plate

Nodular melanoma

This subtype occurs in 15–30% of patients. It is seen most commonly on the legs and trunk in men and women. Rapid growth occurs over weeks to months making this subtype responsible for most thick melanomas.

Lentigo maligna melanoma

The incidence of lentigo maligna subtypes (in situ and invasive) appears to be rising in many countries. It is typically located on the head, neck, and arms (chronically sun-damaged skin) of fair- skinned older individuals (average age of 65) and grows slowly over 5–20 years.

Text C

The skin biopsy is a simple but essential clinical skill of the general practitioner. Performed properly, it can be quick and comfortable for the patient, and yield a very high level of diagnostic information.

An excisional biopsy is an appropriate technique for suspected melanomas, subcutaneous or deep dermal tumours, and deep inflammatory processes. It requires more time and skill than other biopsy techniques but yields more tissue for the dermatopathologist and allows for multiple studies if required. The biopsy is performed like any standard excision by removing an elliptical piece of skin with a scalpel blade and closing the wound with sutures. For a pigmented lesion, this should include the entire lesion with a 2 mm margin of normal skin. Ultimately, for optimal histological diagnosis the excision must go to the level of subcutaneous fat.

Good post-operative care will reduce the risk of complications and improve the long-term cosmetic appearance. Risk factors for wound complications include immuno-compromised patients, smoking, and biopsies in the axilla, groin or below the waist. If the patient is immunosuppressed or the biopsy site has a high risk of infection, a single dose of cephalosporin antibiotics (within three hours of the procedure) may be considered. The biopsy site should be covered with an occlusive dressing. This should remain undisturbed for 24 to 48 hours.
Thereafter, until re-epithelialisation is complete, the wound should be gently cleaned daily with tap water, dried by patting the area gently and covered with a simple dressing.

Text D

Encorafenib (Braftovi™)/binimetinib (Mektovi®) combination therapy is indicated for the treatment of patients with unresectable or metastatic melanoma with a BRAF V600E or V600K mutation. Half of patients with melanoma have a mutated form of the BRAF protein in their tumour(s).

Dosage:

BRAFTOVI™ (encorafenib) 450 mg (six 75-mg capsules)

MEKTOVI® (binimetinib) 45 mg (three 15-mg tablets)

Frequency:

BRAFTOVI™ (encorafenib) once daily

MEKTOVI® (binimetinib) twice daily

Duration:

4 weeks

If the patient misses a dose of encorafenib or binimetinib, instruct patients as follows:

Binimetinib: Do not take a missed dose if it is within 6 hours of when the next dose is due. Instead, wait and take the dose at the normal time.

Encorafenib: Do not take a missed dose if it is within 12 hours of when the next dose is due. Instead, wait and take the dose at the normal time.

Reading A: questions 1–6

Cutaneous melanoma

For each of the questions 1–6, decide which text (A, B, C or D) the information comes from. You may use any letter more than once.