Skin Lesions

Primary Lesion

Initial pathologic change

macule, patch, papule, plaque, nodule, wheal, cyst

List all examples of primary lesions

secondary lesions

Evolved changes from skin disorder

excoriation, edema, scale, crust, fissure, scar

List all examples of secondary lesions

special lesions

Neither primary or secondary lesions

telangectasias, purpura, petechiae, comedone

List all examples of special lesions

primary, flat, 1cm, flush, freckles

Macule

• _______ Lesion

• Non-palpable, ____ lesion

• < _ __ in diameter in size

• Lesions are _____ with surrounding skin

• May be brown, red, blue, or hypo-pigmented

• Examples: ________, Nevi, Vitiligo

Primary, macule

Patch

• _______ Lesion

• Similar to ______ but size is >1cm

primary, palpable, 1cm, varied, tags

Papule

• _______ Lesion

• ________ and elevated

• < _ __ in diameter

• Color ______

  • White, yellow, brown, red, blue, violet

• Examples

  • Flat warts

  • Skin ____

Primary, elevated, 1 cm, rough, psoriasis

Plaque

• _______ Lesion

• ________ and palpable lesions

• > _ __ in diameter

• Firm, _____ texture

• Examples

  • _________

  • Seborrheic/Actinic keratosis

Primary, cystic, 1 cm, lipoma

Nodule

• _______ Lesion

• Palpable, solid or ______ lesions

• > _ __ in diameter

• Examples

  • ______

  • Neurofibromatosis

  • Melanoma

Primary, flat, red, white, transient, insect

Wheal

• _______ Lesion

• Rounded or ____-topped

• Pale ___ / _____ in color with varying diameter

• _________ (resolution within 24-48 hours)

• Examples

  • Hives

  • ______ bites

  • Urticaria

Primary, superficial, 1 cm, serous, hemorrhagic

Vesicle

• _______ Lesion

• __________, circumscribed, and elevated

• < _ __ in diameter

• Contains ______ (clear) / ___________ fluid

• Examples

  • chicken pox

  • herpes simplex

  • herpes zoster

primary, 1 cm, superficial

Bulla

• _______ lesion

• vesicle > _ __

• ALWAYS ___________

• Examples

  • Pemphigus vulgaris

Primary, superficial, turbid, size, acne

Pustule

• _______ Lesion

• Circumscribed and ___________ cavities of skin

• Contain ______ material

• varies in ____

• Examples

  • ____

  • Pustular Psoriasis

Primary, liquid, solid, dome, resilient

Cyst

• _______ Lesion

• Cavity containing ______, semi-solid, or _____ material

• Spherical, ____-shaped papule/nodule

• _________ on palpation

• Examples

  • Milia

  • Mucocele

  • Epidermoid cyst

Secondary, stratum corneum, crusts, scales

Scale

• _________ Lesion

• Flakes of the _______ _______ on the skin surface

• In most cases you will see ______ and ______

• Examples

  • psoriasis

  • Scaling rashes: scarlet fever, Kawasaki Disease

Secondary, serum, purulent, friable, adherent

Crust

• ________ Lesion

• Dried _____, blood, or ________ material on the surface of the skin

• May be thin/delicate/_______ OR thick/________

• Examples

  • Impetigo

  • Ecthyma

Secondary, epidermis, inflammation, markings

Lichenification

• ________ Lesion

• Thickening of the ________ secondary to chronic ___________

• Dry, leathery, thick skin with accentuation of skin ________

• Examples

  • Chronic dermatitis

  • Lichen planus

Secondary, sharply, dermis

Fissure

• __________ Lesion

• Linear, _______ defined

• Deep split / vertical loss of skin into the ______

• Examples

  • Callous

  • Angular cheilitis

secondary, epidermis, scar, rupture

Erosion

• _________ Lesion

• Defect of the _________ ONLY

• Sharply defined, red, oozes, and heals WITHOUT a ____

• Follows _______ of vesicle/bulla/chemical injury

• Examples

  • Drug rash

  • Chemical burn

Secondary, dermis, tissue, scarring

Ulceration

• _________ Lesion

• Skin defect that extends INTO the ______ within pathologically altered tissue

• Heals WITH ________

• Examples

  • Venous ulcer

  • Decubitus ulcer

Secondary, connective, traumatized

Scar

• ________ Lesion

• Proliferation of _________ tissue that has replaced previously inflamed or ___________ skin

• Examples

  • Post surgical wounds

  • Burns

Secondary, depression, diminution, aging

Atrophy

• ________ Lesion

• _________ / surface changes in the skin as a result of ___________ of some/all layers of the skin

• Examples

  • _____

  • Striae

Secondary, necrosis, heparin

Eschar

• ________ Lesion

• Results from tissue _______

• Black

• Examples

  • _______ necrosis

  • Ischemic wound

Secondary, linear, acute

Excoriation

• ________ lesion

• ______ or punctate erosion of the epidermis

• _____ and superficial

• Examples

  • Scabies

  • Atopic dermatitis

Special, vein, 1 mm

Telangiectasia

• _______ Lesion

• Dilated, superficial ____

• < _ __ in diameter

• Examples

  • Systemic sclerosis

  • Spider veins

Special, non-blanchable, thrombocytopenia

Petechiae

• _______ Lesion

• Non-palpable, ___-__________ pinpoint macules

• Commonly associated with _______________

• Examples

  • Vasculitis

  • Immune Thrombocytopenia

Special, non-blanching, palpable, hemorrhage

Purpura

• _______ Lesion

• ___-_________ red/purple macules, papules, or plaques

• ± ________

• Results from __________ into skin

• Examples

  • Rocky mountain spotted fever

  • Acute meningococcemia

Special, extravasation, hemorrhage, trauma, geometric

Ecchymosis

• _______ Lesion

• Collection of blood beneath the skin due to ____________ from vessels

  • Most common form of __________ in the skin

• Typically induced by ______ and _________ in shape

• Examples

  • Bruising

Special, parasite, scabies, worms

Burrow

• _______ Lesion

• Narrow, elevated, tortuous channel produced by a ________

• Example

  • _______

  • _____

Color

Used to further evaluate identified lesions

• red, purple, pink, tan, brown, black, blue

• Is it uniform or varied?

Margination

Used to further evaluate identified lesions

• Well or ill-defined?

• can borders be easily traces with a pencil?

Shape

Used to further evaluate identified lesions

• round, oval, polygonal, annular, iris, serpiginous, umbilicated, nummular

Palpation/Induration

Used to further evaluate identified lesions

• Consistency: soft, firm, hard, fluctuant, indurated

• Temperature

• Mobility

Number

Lesions can be characterized by ______ (single or multiple)

Arrangement

Lesions can be characterized by ___________ (grouped, linear, reticular, serpiginous, diffuse)

Distribution

Lesions can be characterized by ______ (Extent, pattern)

Iris

What shape is this lesion?

Serpiginous

What shape is this lesion?

umbilicated

What shape is this lesion?

Nummular

What shape is this lesion?

Round

What shape is this lesion?

oval

What shape is this lesion?

Arcuate

What shape is this lesion?

annular

What shape is this lesion?

polygonal

What shape is this lesion?