msk 2 module

primary lesions

• macule

• patch

• papule

• plaque

• nodule

• tumor

• wheal

• vesicle

• bullae

• pustule

macule

• <1 cm

• no elevation

• no fluid

• color change from surrounding skin

patch

• 1+ cm

• no elevation

• no fluid

• color change from surrounding skin

• large macule

papule

• circumscribed

• solid elevation

• no visible fluid

• <1 cm

plaque

• broad papule

• 1+ cm

• flat top elevation

• no fluid

nodule

• large papule

• 1+ cm but typically less than 2cm

• elevation possible but can also be centered in dermis or SQ fat

• no fluid

tumor

• large nodule

• 2+ cm

• elevation possible but can also be centered in dermis or SQ fat

• no fluid

wheal (hives)

• evanescent

• edematous

• plateau like elevation

• blanching

• no fluid

• any size

vesicle

• circumscribed

• fluid filled

• epidermal elevation

• < 1 cm

• no blanching

bullae

• large vesicle

• 1+ cm

• elevation

• no blanching

• fluid filled

pustule

• small elevation containing purulent material

• no blanching

• fluid filled

• small

secondary lesions

• scale

• crust

• erosion

• ulcer

• fissure

• scar

scale

• dry/greasy laminated mass of keratin

• pathologic exfoliation

• appear silver if air trapped

crust

• dried serum, pus, or blood

• serum: yellow

• purulent exudate: green, yellow-green

• blood: brown, dark red, or black

erosion

• loss of all, or portions, of epidermis alone

• may or may not crust

• heals w/o scar

ulcer

• local excavation of surface of an organ or tissue

• complete loss of epidermis and some portion of dermis

• heals with some degree of scarring

fissure

crack or cleft thru epidermis or into dermis

scar

• new connective tissue that has replaced lost substance in dermis or deeper parts due to injury or disease

• can be depressed or thickened, lighter or darker

keloid

exuberant proliferation of scar tissue beyond the limits of the original injury

distribution

dermatomal pattern

grouping

characteristic of certain diseases

configurations

• linear: lesions in lines

• annular: forms a complete circle

• targetoid: forms a target

• arcuate: forms a portion of a circle

• polycyclic: several intersecting portions of circles

• serpiginous: not straight, but also does not form circle

• guttate: round lesions like small drops

• nummular: larger coin-like lesions

color

• hypopigmented: appears lighter than surrounding skin due to loss of only part of pigment

• hyperpigmented: appears darker than surrounding skin

• depigmented: true loss of pigment of skin

• erythematous: red lesions, sometimes blanching

• violaceous: deep purple, red lesions

• purpuric: nonblanching erythematous vascular lesions

consistency

• hard: Ca2+ deposit

• firm: fibrous tumor or keloid

• soft: lipoma (fatty and squishy)

• fixed/nonmovable: LN is suggestive of cancer

• freely movable: movable w/ palpation such as normal LN

• fluctuant: fluid filled such as large cyst filled w/ pus, feels if pushed too hard will pop like balloon

• blanches: turns lighter in color when pressed gently before resuming its natural

• nonblanching: does not turn color when gently pressed, suggests purpuric lesions

• verrucous: rough surface, like a wart

hyperesthesia/anesthesia

• painful

• burning

• tender to palpation

• decreased sensation

telangiectasia

dilated cutaneous blood vessel

purpura

brownish or purplish macules due to multifocal extravasation of blood into skin or mucus membranes

types of purpura

• petechiae

• ecchymosis

• hematoma

petechiae

superficial, pinhead (<3mm), round, hemorrhagic, nonblanching macule

ecchymosis

flat, irregularly, shaped nonblanching, blue-purplish patch due to deeper and more extensive interstitial hemorrhage

hematoma

fluctuant nodule that is due to pool-like collection of blood in tissue

atrophy

thinning or depression of skin due to reduction of underlying tissue

striae

depressed lines or bands of thin, reddened skin which later become white, smooth, shiny, and depressed due to stretching of the dermis

cyst

papule or nodule filled with debris that has a lining or sac

comedone

• primary lesion of acne

• open: flat or slightly elevated papule w/ dilated central opening filled w/ blackened keratin

  • blackhead

• closed: 1mm yellowish papules

  • whitehead

abscess

• confined collection of pus w/in dermis and deeper skin tissue

• painful, tender, fluctuant, erythematous nodules

furuncle

acute, round, tender, circumscribed, perifollicular abscess that generally ends in central suppuration

carbuncle

deep multicompartment abscess along fascia that erupts at multiple adjacent sinuses, often appearing as 2+ confluent furuncles

burrow

linear lesion in stratum corneum secondary to scabies mite

lichenification

thickening of skin due to repeated irritation, often from scratching

excoriation

punctate or linear abrasion produced by mechanical means, often from scratching