Integument

Question 1

complete morphologic description of a given skin lesion/condition must include

Answer 1

• type of lesion (primary or secondary)
• color/shape/texture
• configuration
• distribution/location

Question 2

Primary Lesions

Answer 2

• direct result of pathologic process
  
  • macule
  • patch
  • papule
  • plaque
  • nodule
  • tumor
  • vesicle
  • bulla
  • pustule
  • cyst

Question 3

Macule

Answer 3

• small spot; not palpable; < 1cm
• flat

Question 4

Patch

Answer 4

• large spot; not palpable; > 1cm
• arises de novo or through coalescence of macules
• flat

Question 5

Papule

Answer 5

• small bump; superficial, elevated, < 1 cm
• raised

Question 6

Plaque

Answer 6

• large bump; superficial, elevated, > 1 cm
• arises de novo or through coalescence of papules
• raised

Question 7

Nodule

Answer 7

• significant deep component, small bump < 1 cm
• Has Depth, Palpable

Question 8

Tumor

Answer 8

• significant deep component, large bump > 1 cm
• not neoplasm
• Has Depth, Palpable

Question 9

Vesicle

Answer 9

• small bubble, fluid-filled, usually superficial, < 0.5 cm
• fluid-filled

Question 10

Bulla

Answer 10

• large bubble, fluid-filled, can be superficial or deep, > 0.5 cm
• vesiculobullous lesions are almost always clinically important
• fluid-filled

Question 11

Pustule

Answer 11

• pus-containing bubble; often categorized as follicular or nonfollicular (wrt hair follicle)
• follicular: generally indicative of local infection
• folliculitis: superficial, generally multiple
• furuncle: deeper form of folliculitis
• carbuncle (“boil”): deeper, multiple follicles coalescing
• nonfollicular: may indicate systemic infection

Question 12

Cyst

Answer 12

• a sac containing fluid or semisolid material (cells or cell products)

Question 13

Specific Primary Lesions

Answer 13

• wheal/hive
• burrow
• comedone
• atrophy
• keloid
• fibrosis
• petechiae
• telangiectasis
• milium

Question 14

Wheals, Hives

Answer 14

• short-lived (<24 hours) edematous, well-circumscribed papules or plaques seen in urticarial

Question 15

Burrow

Answer 15

• small threadlike curvilinear papule
• virtually pathognomonic of scabies

Question 16

Comedone

Answer 16

• can be open (whitehead) or closed (blackhead)

Question 17

Atrophy

Answer 17

• thinning of epidermal and/or dermal tissue

Question 18

Hypertrophic scar, keloid

Answer 18

• hypertrophic scars
  
  • do not overgrow original wound boundaries
• keloids
  
  • more exuberant in growth (extending beyond wound boundaries) and more chronic in nature

Question 19

Fibrosis, Sclerosis

Answer 19

• dermal scarring/thickening reactions

Question 20

Petechiae, Purpura, Ecchymosis

Answer 20

• red cells outside the vessel walls; non-blanchable

Question 21

Telangiectasis

Answer 21

• dilated superficial dermal vessels

Question 22

Millium

Answer 22

• a small superficial cyst containing keratin (usually < 1-2 mm in size)

Question 23

Secondary Lesions

Answer 23

• result of alteration or evolution of a primary lesion (e.g. rubbing, scratching, necrosis)
  
  • scale
  • crust
  • excoriation
  • lichenification
  • maceration
  • fissure
  • erosion
  • ulcer

Question 24

Scale

Answer 24

• accumulation or excess shedding of stratum corneum
• very important characteristic in differential diagnosis à presence implies epidermis is at least involved in the process
• typically present in conditions with epidermal inflammation à psoriasis, tinea, eczema

Question 25

Crust

Answer 25

* dried exudate (i.e. blood, serum, pus) on skin surface

Question 26

Excoriation

Answer 26

* loss of skin due to scratching or picking

Question 27

Lichenification

Answer 27

* an increase in skin lines/creases produced by chronic rubbing

Question 28

Maceration

Answer 28

* raw, moist, wet tissue

Question 29

Fissure

Answer 29

* a linear crack in the skin * often very painful

Question 30

Erosion

Answer 30

* superficial open wound, loss of epidermis or mucosa only * usually heals without scarring * open wound

Question 31

Ulcer

Answer 31

* deeper open wound with partial or complete loss of dermis or submucosa * usually heals with scarring * open wound