1T 1:00 – 3:00 P.m. Pdx: The Skin Exam

Front 1

All possibilities for primary lesions

Back 1

macule -> patch
papule -> nodule -> mass
wheal (urticaria)
vesicle -> bulla
cyst
pustule

Front 2

All possibilities for secondary lesions

Back 2

plaque
scale
crust
erosion
ulcer
fissure
scar
lichenification

Front 3

All possibilities for shape or configuration of lesions

Back 3

annular
iris or targetoid
gyrate
linear
nummular or discoid
polymorphous
punctate
serpiginous
atrophy
striae

Front 4

All possibilities for location and distribution of lesions

Back 4

solitary
satellite
grouped
confluent
diffuse
discrete
generalized
localized
symmetrical vs asymmetrical
zosteriform or dermatomal

Front 5

Template sentence for describing lesions

Back 5

On the _____ is/are
a ____ cm, ____ (color),
well-defined / ill-defined,
____ (secondary changes),
____ (primary lesion)
in a ____ distribution.

Front 6

4 taboo words in dermatology

Back 6

1. Lesion - say what the exact lesion is
2. Area - meaningless
3. Rash - instead, use eruption
4. Maculopapular - overused, lost meaning

Front 7

Back 7

MACULE if < 0.5 cm; PATCH if > 0.5cm
Flat
Non-palpable

Front 8

Macule; Patch

Back 8

A change in skin color, without elevation, that is flat and flush with the surrounding skin. The lesion is described as a "patch" if greater than 0.5cm.

Front 9

Back 9

On the upper and lower lip, there are 4mm ill-defined black macules.

(This is Peutz-Jeghers Syndrome - a familial colon cancer syndrome)

Front 10

Back 10

On the right antecubidal fossa, there is a 4cm by 4cm T shaped ill defined red patch, and smaller red 4mm by 10mm ill-defined macules and patches surrounding it (or "in a satellite distribution").

Front 11

Back 11

PAPULE if < 0.5cm; NODULE if > 0.5cm; MASS if > 4 or 5 cm
Raised
Round-topped

Front 12

Papule; Nodule; Mass

Back 12

A PAPULE is an elevated solid lesion less than 0.5 cm.

A NODULE is a raised solid lesion that extends deeper into the dermis and is larger than 0.5cm.

A MASS is a solid growth much larger than a nodule. Formerly known as "tumor"

Front 13

Back 13

On the scalp, there is a 4mm brown well-defined papule.

(This is a melanocytic nevus or melanocytic hamartoma)

Front 14

Nevus; hamartoma

Back 14

NEVUS: mole
HAMARTOMA: a collection of cells of the same type that are increased in number.
A nevus is a hamartoma that occurs in the skin.

Front 15

Back 15

On the (where?), there is a 7 mm well-defined erythematous, smooth, pearly nodule.

(This is basal cell carcinoma, which usually involves a papule or nodule that is smooth and pearly (= transluscent)).

Front 16

Morbilliform eruption of measles

Back 16

An eruption comprised of either macules coalescing into patches or papules coalescing into thin plaques.

Front 17

Back 17

On the upper back, there are scattered 2.5cm-3cm slightly pink ill-defined subcutaneous nodules.

(We know it's subcutaneous because you can still see the skin lines intact with hair -- it's been pushed up. This guy previously had metastatic B cell lymphoma that metastasized to the skin. Malignancies that metastasize to the skin often present as subcutaneous nodules.)

Front 18

Back 18

On the left medial ankle there is a 5 by 6 cm ill-defined pink scaly oval mass.

Front 19

Back 19

WHEAL
Edematous plaque
Peripheral redness
Transient (<24 h)
"hive" in layman's terms

Front 20

Wheal

Back 20

A raised fleeting elevation in the skin irregularly shaped due to the presence of edema

(To figure out: circle some of these lesions and ask them to come back a few hours later. If they're gone by then, then they probably have wheals.)

Front 21

Back 21

On the (where?), there are ill-defined pink (size?) wheals.

(My guess; Dean Zic didn't say)

Front 22

Back 22

On the trunk, there are pink ill-defined scattered 4mm to 22mm wheals.

(My guess; Dean Zic didn't say)

Front 23

Back 23

VESICLE if < 0.5cm; BULLA if > 0.5cm
raised
contains bubble of clear serous fluid

(To figure out if there is fluid inside, take a cotton tipped wooden applicator, snap it to get a sharp wooden point, and poke the lesion to see if it drains clear fluid).

Front 24

Vesicle; Bulla

Back 24

VESICLE: An elevated, sharply defined lesion containing serous fluid, less than 0.5cm

BULLA: A large elevated fluid-filled lesion greater than 0.5cm (plural: bullae)

Front 25

Back 25

On the left side is a cluster of 2-3mm yellowish vesicles. In addition, there is an ill defined 3-4cm patch of erythema.

Front 26

Back 26

On the side of the trunk, there are a cluster of some 3-4mm dark crusted vesicles and some 3-4mm dark intact vesicles. There is also an ill-defined 4-5cm erythematous patch.

Front 27

Back 27

On the lower right leg, there are 2-4mm vesicles. In addition, there are targetoid-appearing (=concentric rings of different colors) 1.5cm bullae with a central hemorrhagic (something?).

(When you have a lot of serous fluid, it turns more and more yellowish. It turns red because of bleeding from broken blood vessels.)

Front 28

Back 28

CYST
any size
raised
containing liquid or semisolid material
encapsulated

Front 29

Cyst

Back 29

An elevated thick-walled lesion containing fluid or semisolid matter.

(Draining this will give you sinovial fluid which is clear and has the consistency of KY jelly.)

Front 30

Back 30

On the ventral index finger, there is a 1.4cm ill-defined cyst.

(My guess; Dean Zic didn't say)

Front 31

Back 31

On the scrotum, there are scattered well-defined 2-8mm cysts.

(My guess; Dean Zic didn't say)

Front 32

Back 32

PUSTULE if < 0.5cm; FURUNCLE (boil, abscess) if > 0.5cm
raised
containing purulent exudate

Front 33

Pustule; Furuncle

Back 33

PUSTULE: An elevated lesion, less than 0.5cm, containing purulent material.

Lesions larger than 0.5cm are described as boils, abscesses, or FURUNCLES.

Front 34

Back 34

On the left leg, there are 2-3mm red pustules with surrounding erythema.

Front 35

Back 35

On the (where?), there are well-defined 1-4mm white satellite pustules.

(This is psoriasis)

(My guess; Dean Zic didn't say)

Front 36

Back 36

On the (which?) foot, there are three red, ill-defined, 2cm furuncles.

Front 37

Hierarchy of primary lesions in guiding diagnosis

Back 37

When there are multiple primary lesions, the order of importance in guiding diagnosis is:
1. Vesicles/Bullae
2. All other primary lesions
3. Macules/Patches

Front 38

Back 38

PLAQUE
> 1.0cm
raised
flat-topped

Front 39

Plaque

Back 39

A raised flat-topped solid lesion formed from a confluence of papules or nodules

(On the edge, you would feel approximately the thickness of a necktie)

Front 40

Back 40

On the anterior abdomen, there are well-defined (size and distribution?) scaly pink plaques.

(This is psoriasis)

Front 41

Scale

Back 41

Dried fragments of sloughed dead epidermal cells (corneocytes, specifically), irregular in shape and size: white, tan yellow, or silver in color. Major component of household dust.

(No cartoon given)

Front 42

Crust

Back 42

Dried serum, sebum, blood, or pus that forms on the surface of the skin producing a temporary barrier to the environment. Aka "scab".

(Cartoon not given)

Front 43

Back 43

On the right lateral arm, there is an eruption of serpiginous (snake-like) pink plaques (slightly elevated and flat topped) in a wood-grain distribution.

(This is erythema gyratum repens. The cancer has triggered and immune reaction, and the T cells have come to the skin, triggering a skin eruption.)

Front 44

Back 44

On the medial right cheek, there is a thick black 2cm by 3cm crust overlying an ulcer. In addition, there is a surrounding 4cm firm/indurated erythametous ill-defined plaque.

(This was infection by filamentous bacteria, after being poked by a branch during gardening)

Front 45

Back 45

FISSURE
linear ulcer, sharply defined

EROSION
loss of superficial layers of epidermis

ULCER
Loss of entire epidermis + loss of entire or part of dermis

Front 46

Fissure

Back 46

A deep linear split through the epidermis into the dermis: a linear ulcer

Front 47

Erosion

Back 47

A moist, demarcated depressed area due to loss of partial or full thickness of the epidermis. The basal layer of the epidermis remains intact.

Front 48

Ulcer

Back 48

An irregularly shaped exudative depressed lesion in which the entire epidermis and at least the upper layer of the dermis is lost. Results from trauma and tissue destruction.

Front 49

Back 49

On both cheeks of the buttocks, there is a 4.5cm by 4.5cm flat, moist, pink, wet erosion. This resulted from a large deflated bulla.

Front 50

Back 50

On the chest and abdomen, there are scattered 5mm-18mm erythematous ill-defined erosions. These result from unroofed bullae.

(This is pemphigus vulgaris, in which antibodies are being launched at the hemidesmosome.)

Front 51

Unroofing of which 3 primary lesions results in the secondary lesion called an erosion?

Back 51

Vesicle
Bulla
Pustule

Front 52

Back 52

Ulcer

Front 53

Back 53

fissure

Front 54

Back 54

EXCORIATION
Linear abrasion of the epidermis
Results from scratching

LICHENIFICATION
Thickened epidermis
Increased skin lines
Results from scratching
(Thickening in lichenification is actually a physiologic response so the skin is less likely to tear during chronic scratching.)

Front 55

Excoriation; Lichenification

Back 55

EXCORIATION: Superficial linear abrasion of the epidermis. A visible sign of itching.

LICHENIFICATION: Epidermal thickening resulting in an elevated plaque with accentuated skin markings. Usually a result of repeated injury through rubbing or itching.

Front 56

Back 56

lichenification

(Notice increased skin lines going in two directions and thickened skin, in response to scratching)

Front 57

Back 57

Lichenification (verify!)

Front 58

Telangiectasia

Back 58

A blanching dilated capillary

(Vascular lesion)

Front 59

Petechiae

Back 59

A nonblanching pinpoint or small blood red macule

(Vascular lesion)

Front 60

Ecchymosis or purpura

Back 60

A nonblanching purple or discolored patch, a bruise

(Vascular lesion)

Front 61

Hematoma

Back 61

A deep collection of blood in the depp dermis or subcutaneous tissue, often a nonblanching purplish mass

Front 62

Annular

Back 62

Ring-shaped

+/- central clearing

(Lesion configuration)

Front 63

Iris or targetoid

Back 63

Concntric circles / "bulls eyes"

+/- central vesicle

(Lesion configuration)

Front 64

Gyrate

Back 64

ring-spiral shape

(Lesion configuration)

Front 65

Linear

Back 65

in a line

(Lesion configuration)

Front 66

Nummular or discoid

Back 66

Coin-like
More oval than round

(Lesion configuration)

Front 67

Serpiginous

Back 67

snake-like / cord-like

(Lesion configuration)

Front 68

Polymorphous

Back 68

occurring in several forms

(Lesion configuration)

Front 69

Punctate

Back 69

Marked by points or dots

(Lesion configuration)

Front 70

Atrophy

Back 70

wasting of the epidermis in which the skin appears thin and transparent or in the dermis in which a focal area of depression is observed

(Lesion configuration)

Front 71

Striae

Back 71

Depressed bands of thin white shiny skin

(Lesion configuration)

Front 72

Solitary

Back 72

A single lesion

(Lesion distribution)

Front 73

Satellite

Back 73

Single lesion in close proximity to a large grouping Usually macules or pustules.

(Lesion distribution)

Front 74

Grouped

Back 74

Cluster of lesions

(Lesion distribution)

Front 75

Confluent

Back 75

Merging together

(Lesion distribution)

Front 76

Diffuse

Back 76

Widely distributed

(Lesion distribution)

Front 77

Discrete

Back 77

Separate from other lesions

(Lesion distribution)

Front 78

Generalized

Back 78

Distributed diffusely

(Lesion distribution)

Front 79

Localized

Back 79

Limited areas of involvement which are defined clearly

(Lesion distribution)

Front 80

Symmetrical vs asymmetrical

Back 80

Distributed bilaterally or unilaterally

(Lesion distribution)

Front 81

Zosteriform or dermatomal

Back 81

Band-like distribution along a dermatome area