Description of Skin Lesions Flashcards by Carolyn Ziebol

Macule

type of primary lesion with below qualities:
- lesion is flat (non-palpable)
- lesion measures less than 1 cm
- not filled with any material
- color change of skin only
ex: think like freckles!

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Patch

type of primary lesion with below qualities:
- lesion is flat
- measures greater than or equal to 1 cm
- not filled with any material
- color change only
ex: vitiligo

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Papule

type of primary lesion with below qualities:
- lesion is raised but may have a depressed portion (center)
- superficial
- lesion measures less than 1 cm
- includes solid content (hard, no fluid)
ex: blue nevus

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Plaque

type of primary lesion with below qualities:
- lesion is raised or depressed
- measures greater than or equal to 1 cm
- has solid content (no fluid inside)
- well-defined
- can form when papules coalesce (combine or come together)
ex: pityriasis rosea

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Nodule

type of primary lesion with below qualities:
- lesion is raised
- measures greater than or equal to 1 cm
- contents can be solid or fluid
- larger and deeper than a papule
ex: basal cell carcinoma

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Vesicle

type of primary lesion with below qualities:
- lesion is raised
- measures less than 1 cm
- contents are fluid (clear, serous, or hemorrhagic)
- dome-shaped or flaccid
- roof: often thin
- arise from cleavage at the superficial level
ex: varicella zoster

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Bulla (Bullae)

type of primary lesion with below qualities:
- lesion is raised
- lesion measures greater than or equal to 1 cm
- contents are fluid (clear, serous, or hemorrhagic)
ex: bullous pemphigoid

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Pustule

type of primary lesion with below qualities:
- lesion is raised
- lesion measures less than 1 cm
- contents are fluid (pus)
- superficial
ex: insect bite

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Erosion

type of primary lesion with below qualities:
- lesion is depressed
- can measure any size
- no contents
- focal loss of epidermal tissue (but NO dermis loss)
- heals without scarring
- seen in some inflammatory conditions
- erosions may be secondary lesions (ex: bulla that popped)

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Ulceration

type of primary lesion with below qualities:
- lesion is depressed
- measures to any size
- no contents
- loss of epidermis and at least a portion of the dermis
- deeper than an erosion due to loss of epidermis and dermis (sometimes subcutaneous tissue as well)
- leaves a scar
- ulcers may be secondary lesions

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Wheal

type of primary lesion with below qualities:
- circumscribed
- irregular size and shape that can change
- transient (lasts less than 48 hrs usually)
- produced by cutaneous edema
- red to pale in color
- frequently itchy
ex: urticaria (hives) involves wheals!

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Ecchymosis

type of primary lesion with below qualities:
- usually referred to as a bruise
- can be multiple colors
- size: > 3mm
- due to blood leaving the vessels
- does not blanch when pressure is applied

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Petechiae

type of primary lesion with below qualities:
- deep red/reddish purple in color
- size: 1-3 mm
- round and flat
- can occur on mucous membranes too
- due to blood leaving vessels
- do not blanch when pressure is applied

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Purpura

type of primary lesion with below qualities:
- deep red/reddish purple in color
- size: larger than petechiae
- can be irregularly shaped
- may be palpable
- due to blood leaving vessels
- does not blanch when pressure is applied

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Scale

type of secondary lesion with below qualities:
- excessive accumulation of stratum corneum
- flakes: can be large, tiny, adherent, or loose but normal with this type of lesion
ex: psoriasis

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Crust

type of secondary lesion with below qualities:
- dried exudate of body fluids
- serous crust: yellow
- hemorrhagic crust: red/black
ex: impetigo

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Lichenification

type of secondary lesion with below qualities:
- distinctive skin thickening
- accentuated skin-fold markings
- result of chronic scratching/rubbing
ex: eczema

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Erosion & Ulcer

two similar types of secondary lesions:
erosion: a bulla that unroofs
ulcer: a nodule that ulcerates

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Excoriation

type of secondary lesion with below qualities:
- linear, angular erosion
- may be covered by crust
- caused by scratching

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Scar

type of secondary lesion with below qualities:
- skin change secondary to trauma/inflammation (fibrous tissue)
- may be erythematous
- may be hypopigmented
- may be hyperpigmented
- hair follicles may be destroyed

Atrophy

type of secondary lesion w/below qualities:
- an acquired loss of substance
- example: loss of epidermis -> leads to shiny quality of skin with “cigarette paper” wrinkling
- example: loss of the dermis or subcutaneous tissue, depressed lesion
- underlying vessels may be revealed

Fissure

type of secondary lesion w/below qualities:
- linear lesion (crack)
- skin or mucosa could be damaged
- result of excessive tension or decreased elasticity of the tissue

Number of Lesions

always address and count the number of lesions on a PE (as long as not too many)

Size of Lesion

measure lesion w/a ruler during PE
use mm or cm depending on size
if lesion is opal shaped: measure long axis first and then measure the perpendicular axis to the long axis
if there are multiple lesions, note range in size between lesions

Shape of lesion

the shape of a lesion can be defined by many terms including the following: - circular - oval - annular - nummular - polygonal - arcuate - reticular - serpiginous

Annular

used to describe a lesion that is: - ring-like with a central clearing - color/texture is more prominent at the edge

Nummular

used to describe a lesion that is: - coin-like, with no central clearing

Polygonal

used to describe a lesion that is: - varied, non-geometric shape

Arcuate

used to describe a lesion that is: - arc-shaped; result of incomplete formation of annular lesion

Reticular

used to describe a lesion that is: - net-like or lacy

Serpiginous

used to describe a lesion that is: - serpentine or snake-like

Color of Lesion

make sure to mark the color of the lesions you are looking at during a PE - color of lesions varies wildly - lesions can be red, purple, brown, black, or tan just depends on the type

Texture of Lesion

palpate the lesion during the PE to determine its texture; texture usually is like: - smooth - fleshy - verrucous/warty - scaly (either fine (dry), hyperkeratotic (hard/crusty), or greasy)

Location/Distribution of lesion

make sure to mark during the PE where you saw the lesions and how they are distributed aka what region of body and where - for ex, say "axilla" over armpit to describe a lesion there

Photodistributed Lesion

lesions only located on sun-exposed areas

Acral

lesions only located on distal locations of body (hands, feet, wrists, ankles, etc.)

Truncal

lesions only located on the trunk of the body

Extensor vs Flexor Surfaces

lesions located on areas that are frequently flexed or extended where regions of the body are touching and creating friction, sweat, etc.

Intertriginous

lesions located within skin folds

Generalized

located all over the body w/no particular pattern

Localized

lesions are located in a specific area of the body

Symmetric

lesions are located symmetrically on the body

Asymmetric

lesions are located asymmetrically on the body

Discrete

lesions are located in small areas scattered across the body

Grouped

lesions are grouped in bundles across the body

Coalescing

lesions are existing together in large groups in one area of body

Cleavage Plane

lesions located across cleavages of body

Configuration of Lesions

note during the PE the pattern of th lesions and how they are arranged in relation to one another

Classic Features of Lesions

if lesions are pathognomonic for a particular diagnosis, include that in your description (PE documentation) - use buzz words ex: "Christmas tree distribution, grouped vesicles on an erythematous base," etc.