Skin Lesions and ID

Question 1

Primary Skin Lesions

Answer 1

Arise de novo in the skin
Represents initial cutaneous pathologic changes
Uncomplicated lesions
Uninfluenced by secondary alterations- Progression of the disease; Scratching; Infection

Question 2

Macule

Answer 2

circumscribed change in skin color without elevation or depression of the surface; <
1 cm in diameter
 Examples: erythema; purpura; café au lait; vitiligo; freckles; flat moles (nevi); petechiae;
measles; scarlet fever

Question 3

Patches

Answer 3

a flat, nonpalpable irregular shaped macule > 1 cm in diameter
 Examples – Vitiligo; port-wine stains; Mongolian spots; café au lait patch

Question 4

Papules

Answer 4

solid, elevated circumscribed area < 1 cm in diameter
 Implies pathologic involvement of:
 Epidermis – especially if there is scaling or disturbance of the normal surface of
the epidermis
 Dermis – usually epidermal surface is normal but redness is present
Examples – warts; molluscum contagiosum; lichen planus; elevated moles (nevi)

Question 5

Nodules

Answer 5

solid, elevated circumscribed area similar to a papule but 1 to 2 cm in diameter and
deeper in the dermis with visible elevation of the skin
 Implies pathologic involvement of Epidermis
o may be associated with scale, erosion, and loss of skin markings
• or Dermis
o May be fluctuant (e.g. cyst) or firm (e.g. skin cancer)
• Examples – cyst; basal cell carcinoma; erythema nodosum; lipoma

Question 6

Tumors

Answer 6

elevated and solid lesion 
 may or may not be clearly demarcated 
 deeper in dermis 
 > 2 cm in diameter 
 Examples – neoplasms, benign tumors. lipomas

Question 7

Plaques

Answer 7

elevated, firm, and rough lesion with flat top surface > 1 cm in diameter
 evolve from a confluence of papules
 Only slightly elevated relative to their large surface area
 Examples – psoriasis, urticaria, mycosis, fungoides, seborrheic and actinic keratoses

Question 8

Vesicle

Answer 8

elevated, circumscribed, superficial, not into dermis
 filled with serous fluid
 < 1 cm in diameter
 Examples – varicella (chicken pox); herpes zoster (shingles); pemphigus; pemphigoid

Question 9

Bullae

Answer 9

vesicle > 1 cm in diameter
 May evolve within the epidermis in which case the fluid is usually clear serous
 Lesions may be flaccid and break easily (thin roof)
 May evolve at the DEJ (thick roof) – lesions are tense may contain hemorrhagic fluid. Less
likely to rupture.
 Examples – blister; pemphigus vulgaris

Question 10

Pustule

Answer 10

elevated, superficial lesion; similar to vesicle but filled with purulent fluid.
 Examples – acne vulgaris, folliculitis, impetigo

Question 11

Cyst

Answer 11

Elevated, circumscribed, encapsulated lesion; in dermis or subcutaneous layer; filled with liquid
or semi-solid material.
 Examples - sebaceous cyst, cystic acne

Question 12

Wheals

Answer 12

 Special type of plaque
 A slight elevation caused by movement of fluid out of blood vessels
 Elevated, irregular-shaped area of cutaneous edema
 Solid, transient, variable diameter
 Examples – insect bites, allergic reaction, urticaria (hives)

Question 13

Petechiae

Answer 13

pinpoint, nonraised, round, purplish red spots caused by intradermal of submucous
hemorrhage

Question 14

Purpura

Answer 14

Small hemorrhages in the skin, or mucous membranes

Question 15

Ecchymoses

Answer 15

a hemorrhigic spot in the skin or mucous membrane forming a nonelevated, rounded
or irregular, blue or purplish patch.

Question 16

Telangiectasias

Answer 16

fine, irregular, red lines produced by capillary dilation

Question 17

Arrangement of lesions

Answer 17

Isolated- Melanoma
Scattered- Pityriasis rosea, drug eruption
Herpetiform (Grouped vesicles)
Zosteriform (dermatomal)
Annular (Ring)
Linear
Reticular

Question 18

Distribution of lesions

Answer 18

• Generalized
• Acral (Affecting extremities)
• Intertriginous (apposed skin surfaces)
• Palms and Soles
• Lower Extremities
• Extensor
• Flexor
• Circumscribes
• Truncal
• Hair Bearing
• Mucus Membranes
• Sites of pressure
• Sites of trauma
• Unilateral
• Follicular

Question 19

Secondary Skin Lesions

Answer 19

o Evolve from the preceding visible lesions
o Changes occur because of:
 Progression of the disease
 Scratching (trauma)
 Infection
 Therapies
o These may coexist with primary lesions
o Some overlap exists with primary lesions

Question 20

Scales

Answer 20

flakes composed of aggregates of shedding epidermal cells. Secondary Lesion

Question 21

Crusts

Answer 21

• masses that result from drying exudates of serum, blood, sebum, or purulent material
• Develop after vesicles or bullae break down to release their content.
• Secondary Lesion

Question 22

Ulcers

Answer 22

Loss of epidermis and dermis; concave; varies in size and depth
-Area of skin where skin layers are missing

Question 23

Fissures

Answer 23

• Linear crack or break from the epidermis to the dermis; may be moist or dry
• Area of skin where skin layers are missing

Question 24

Exoriations

Answer 24

• Loss of the epidermis; linear hollowed-out, crusted areas

- Area of skin where skin layers are missing

Question 25

Erosions

Answer 25

-Loss of part of the epidermis; depressed, moist, glistening; follows rupture of a vesicle or
bulla.
-Area of skin where skin layers are missing

Question 26

Lichenification

Answer 26

• an area of skin that is thickened
• increased prominence of skin lines
• Often caused by scratching

Question 27

Scars

Answer 27

– indicate deep involvement or trauma, with subsequent repair that incompletely restores normal skin architecture.
-Secondary Skin Lesion.

Question 28

Keloids

Answer 28

• Hypertrophic Scars

- Secondary Skin Lesion

Question 29

Atrophy

Answer 29

• of epidermis or dermis most often appears as depressions below the level of the surrounding
  skin. Ex: Stretch marks
• Secondary Skin Lesion