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Morphology and Differential Diagnosis Welcome to Dermatology! No matter what area of medicine or surgery you pursue, you will get skin related questions from family, friends, and patients. The time frame is short, so make the best use of your time. Carry your book with you at all times and try to make it through all the photos. Suggestions for a Successful Rotation • Be on Time! • Be attentive and helpful. • Do not ask questions or make comments during the patient encounter. Please ask all questions outside the exam room. • Please do not talk loudly in the hallway. Macule Macule Macule Patch Papule Papules Papules Papules Plaque Plaque Plaque Nodule Nodule Nodule Tumor Tumor Tumor Pustule Pustule Vesicle Vesicle Vesicle Bulla Bulla Wheals Wheals Special Skin Lesions • Burrow: Thin linear papule or plaque • Comedone: Follicular papule filled with keratinous plug which is open or closed • Cyst: Papule or nodule filled with debris • Telangiectasia: Dilated blood vessel less than 1 mm wide Burrow Comedone Telangiectasia Cyst Secondary Lesions • • • • • • • • Scale Crust Erosions and ulcers Excoriations Fissures Scars Lichenification Atrophy Scales Scales Scales Crust Crust Excoriations Erosion Erosion Ulcer Ulcer Ulcer Fissure Fissure Atrophy Atrophy Atrophy Atrophy Scar Lichenification Configuration • • • • • • Annular Arcuate Geographic Discrete Confluent Serpiginous • Linear • Reticulated Annular and arcuate Linear Erythema Subitum Descriptors • • • • • Punctate Lichenoid Umbilicated Scarletiniform, morbiliform Leonine Color • • • • • • • • Pink Violet Orange Blue Green Yellow Black Brown Color • • • • • • • • Pink—Pityriasis rosea Violet—Lichen planus Orange—Juvenile xanthogranuloma Blue—Amioderone skin pigmentation Green—Pseudomonas Yellow—Xanthomas Black—eschar Brown—Café au lait spots Color Distribution Morphologic categories • Macular-Patch • Papular • Papulosquamous (scaly papules) • Nodular • Pustular • Vesicular-bullous • • • • • • • Urticarial Petechial Telangiectatis Burrow Poikiloderma Hyperkeratotic/scale Atrophic “More is missed by not looking than by not knowing” M. McKay, M.D. Procedures • Liquid Nitrogen • Electrodessication and curettage • Biopsy – Punch – Shave – Excision Seborrheic Keratosis • Common Skin Tumor of unknown cause. • Predilection for trunk, scalp, temples • No malignant potential • Increase incidence with age • Easily treated with curettage or cryodestruction Dermatosis Papulosa Nigra • Most likely a subtype of seborrheic keratosis • Malar areas, most commonly on AfricanAmerican women Acrocordons (Skin Tags) • Common, occurring in about 25% of adults • More common in obese individuals and often develop in pregnancy • Frictional areas such as neck, axillae, inframammary and groin locations • Can become irritated or infarcted because of torsion Dermatofibroma • Firm papule often with brown pigmentation, most frequently seen on the anterior legs • “Dimple” sign • May be a reactive process to an insect bite reaction rather than a tumor • If multiple, sometimes associated with systemic lupus erythematosis Dermatofibroma Keloids • Hypertrophic scar which extends beyond the area of injury • May have delayed onset, even up to years after injury • Can be painful • More common in AfricanAmericans • Treatment can be difficult and choices include intralesional steroids, radiation, careful excision, laser ablation Epidermoid Cyst Trichilemmal (Pilar) Cyst Actinic Keratosis Keratosis Pilaris • Follicular papules, commonly on extremities • “sandpaper” feel • 20% of the population affected • Worsens in adolescence • Common in Atopics and icthyosis • May improve with keratolytics, retinoids, dermabrasion Keratosis Pilaris Keratosis Pilaris Cherry Angiomas • Benign vascular proliferation • “senile hemangioma” – don’t use this term with patients • Usually appear on trunk, start at age 30, increase with age • Dilated capillaries • Tx for cosmetic reasons only
