Arch Dermatol. A lesion is any abnormality of tissue or organs. Bacterial skin infections can be classified as skin and soft tissue infections (SSTI) or acute bacterial skin and skin structure infections (ABSSSI). de Villiers EM, Surgical margins for excision of primary cutaneous melanoma. Auspitz sign is the appearance of pinpoint bleeding after scale is removed from plaques in psoriasis. 1997;278:1693–9. Br Med J. Many are harmless and may just be open sores from an injury. The Basics About Skin Cancer . Early recognition of such lesions is important because complete excision will cure almost all cases of skin cancer if performed in the early stages. Cancer. Mohs' micrographic surgery for nonmelanoma skin cancers. 1991;127:1031–3. A 68-year-old man presents with a small lesion on his right cheek, which he says has been there for several weeks. Elder DE, 1997;24:705–18. 1997;37(3 Pt 1):422–9. Orchard GS, The diagnosis is easily confirmed by visualization of fungal elements in the skin scales after exposure to potassium hydroxide under the light microscope. Warner T, - Test your knowledge with the morphology quiz by performing a virtual and interactive "skin exam." Photography for the early diagnosis of malignant melanoma in patients with atypical moles. Close inspection Size of the lesion(s) Assess the size of the lesion(s): measure their width and height (if raised). Telangiectases are foci of small, permanently dilated blood vessels that may occur in areas of sun damage, rosacea, systemic diseases (especially systemic sclerosis), or inherited diseases (eg, ataxia-telangiectasia, hereditary hemorrhagic telangiectasia) or after long-term therapy with topical fluorinated corticosteroids. Human papillomavirus infections in nonmelanoma skin cancers from renal transplant recipients and nonimmunosuppressed patients. Skin Lesions: Definition A skin lesion is a superficial growth or patch of the skin that does not resemble the area surrounding it. Particular body parts are affected (eg, palms or soles, scalp, mucosal membranes). Paget's disease of the nipple appears to be an unresponsive eczema of the areola but actually is a carcinoma in the ducts of the breast that grows outward to involve the skin. Areas exposed to sunlight, radiation or arsenicals, Rough, irregular, sometimes scaly, sometimes has visible vessels, sometimes warty or with fleshy masses, Skin-colored at first, sometimes reddened later, Does not clear with corticosteroid therapy, Keratoacanthoma (a variant of squamous cell carcinoma), Goes through aperiod of very rapid growth, often regresses, Atopic dermatitis behind ears, on flexure areas, Reddened, slightly scaly, sometimes with vesicles, Common in atopic persons and those exposed to irritants, Wherever skin comes in contact with an irritant, Dermatitis clears with corticosteroid therapy, Elbows, knees, scalp, sacral cleft, nails, White dry scales, smooth pink or red wherescales are removed; may bleed, Well-demarcated; round, irregular or confluent, Often widespread, sometimes itchy; varies with season, Scalp, forehead, nasolabial fold, midline trunk. Laryngoscope. There are many types of benign skin lesions, or skin tumors, and they rarely turn into cancers. The skin of elderly persons possesses a greater number of benign growths and neoplasms than the skin of younger and middle-aged persons. Differential expression of desmosomal glycoproteins in keratoacanthoma and squamous cell carcinoma of the skin: an immunohistochemical aid to diagnosis. Spira M. Early detection of malignant melanoma: the role of the physician examination and self-examination of the skin. Congenital nevomelanocytic nevi are brown patches of skin that are present at birth or develop in infancy. Marks R. Skin tumors. The pattern of multiple lesions or the shape of an individual lesion can be useful in narrowing the differential diagnosis. 1. Headington JT, Hanusa BH. Each year members of a different family practice department develop articles for “Problem-Oriented Diagnosis.” This series is coordinated by the Department of Family Practice at the University of Texas Health Science Center at San Antonio. Using the SSD model to identify skin images could help doctors to quickly diagnose skin lesions. There are numerous types of skin lesion. DeSpain J, et al. The other three apps were found to incorrectly categorize a large number of skin lesions, with one missing nearly 30% of melanomas, classifying them as low-risk lesions. They say a picture is worth a thousand words. A few skin lesions resemble malignancies. Although it comprises only 1 percent of skin cancers, malignant melanoma accounts for over 60 percent of skin cancer deaths.13 It metastasizes to remote sites early, and its metastases are characteristically unresponsive to treatment. Clark J, Red skin (erythema) can result from many different inflammatory or infectious diseases. Psoriasis frequently exhibits this phenomenon, as may lichen planus, often resulting in linear lesions. Sign up for the free AFP email table of contents. The epidermis is the topmost layer and is superficial in nature. 8. de Villiers EM, 1/37. By Annie Hauser July 03, 2015. Brown CD, Induration is characteristic of panniculitis, some skin infections, and cutaneous metastatic cancers. Skin cancer is considered to be the most common human malignancy. F1-score is the result of comprehensive sensitivity and accuracy, which was 96% for MF (second only to 96% of PSO). Spira M. Clusters of lesions may occur as fleshy masses (Figure 4). Using the SSD model to identify skin images could help doctors to quickly diagnose skin lesions. Netscher DT, In the initial phase they have a slowly spreading irregular outline. Indurated skin has a hard, resistant feeling. Hunter JA, Syringoid sweat duct carcinoma. App to facilitate skin self-examination and early detection. Lichen planus frequently arises on the wrists, forearms, genitals, and lower legs. 1994;87:1272–6. Plaques may be flat topped or rounded. It may also appear in areas that have been subjected to ionizing irradiation or in other locations in patients who have undergone treatment with immunosuppressive drugs1 or have been exposed to organic trivalent arsenic compounds or tars. Xanthomas, which are yellowish, waxy lesions, may be idiopathic or may occur in patients who have lipid disorders. 5. Urticaria (wheals or hives) is characterized by elevated lesions caused by localized edema. Benchmarks Add a Result. Read more. Aggressive-growth basal cell carcinoma in young adults. A presumptive diagnosis can often be made by considering the patient's risk factors, the history of the lesion and its location, appearance and texture. In farmers and ranchers, the skin of the face, neck and arms is also at high risk. Superficial dilated vessels may be visible. Removal of premalignant lesions will reduce the occurrence of malignant disease. The Merck Manual was first published in 1899 as a service to the community. Psoriasis is a common skin condition that can cause a scaly, itchy, red rash to form along the scalp, elbows, and joints. Regular reexamination of affected skin and treatment of any areas showing growth or change can prevent neoplastic transformation or provide early treatment of malignancy11 (Figure 9). The appearance can range from an almost incidental swelling of tissue to an outbreak of painful eruptive sores. Petechiae are nonblanchable punctate foci of hemorrhage. Dodson J, Kopf AW. Advertisement. Black skin lesions may be melanocytic, including nevi and melanoma. (LOND), University of Texas Health Science Center, San Antonio, Texas. Common skin lesions found in individuals are warts, moles and actinic keratosis. Leigh IM, Lesions that are growing, spreading or pigmented, or those that occur on exposed areas of skin are of particular concern. Elder DE, One can come about in response to an allergy, toxin, infection, or larger systemic disease. JAMA. Benign melanocytic naevi as a risk factor for malignant melanoma. If a biopsy shows dysplasia, the whole lesion should be removed with 5-mm margins using plastic surgical techniques, and the site should be monitored for recurrence. Skin presentations and lesions at every age are commonly seen in primary care. 12. Wagner RF Jr, The top of the head, the face, the neck, the shoulders and the extensor surfaces of the arms are particularly important, but the areola, the vulva and the foreskin are also areas of high risk. et al. CA Cancer J Clin. Reticulated lesions have a lacy or networked pattern. 15. This starts the process of trying to match up their skin condition to the one in the photos. These may be caused by burns, bites, irritant contact dermatitis or allergic contact dermatitis, and drug reactions. 1996;76:394–8. Arch Dermatol. Leigh IM, Benign melanocytic naevi as a risk factor for malignant melanoma. Note the multiple nodules signaling invasiveness of the lesion. Darier sign refers to rapid swelling of a lesion when stroked. In: A manual of skin diseases. Deep dermal nevi appear blue. Lavergne D, No evaluation results yet. Keratoacanthoma: when to observe and when to operate and the importance of accurate diagnosis. Mohs' micrographic surgery for nonmelanoma skin cancers. Primary:Present at birth or acquired it over a lifetime. Syringoid sweat duct carcinoma is a rare malignant condition that occurs on the face or scalp of elderly patients, causing local hair loss. Lesion Identification: - Learn morphologic skin lesion terms and definitions. Address correspondence to Lewis C. Rose, M.B., B.S. Tavin E, / Journals In these cases the definitive excision will require plastic surgical techniques. The common form first appears as a small round or oval area of skin thickening. Holly EA, Cutaneous tumors are often pink or red. The key to identification is its outward appearance and other accompanying symptoms if they exist. When mature, it is volcano-shaped, with protruding masses of keratin resembling lava. Metastatic basal cell carcinoma of the head and neck. Reprints are not available from the author. 1996;88:802–11.... 2. Nodule. Some scars become hypertrophic or thickened and raised. An extensive language has been developed to standardize the description of skin lesions, including, Lesion type (sometimes called primary morphology), Lesion configuration (sometimes called secondary morphology). Circumscribed flat discoloration,>1cm. Clinically recognized dysplastic nevi. Orange skin is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. Keywords: seborrheic keratosis, stucco keratosis, benign melanocytic nevus, actinic keratosis, cutaneous horn, blue nevus, lentigo, porokeratosis The skin of elderly persons possesses a greater number of benign growths and neoplasms than the skin of younger and middle-aged persons. Dermal and subcutaneous lesions. Lesions are most often well circumscribed and round. 16. Finding it early, when it’s small and has not spread, makes skin cancer much easier to treat. Dr. Rose is board certified in family practice in the United Kingdom, Canada and the United States. Blue nevi occasionally become the site of melanocytic malignant change. 17. AKs tend to develop on sun-damaged skin over a long period of time. 3. A history of malignant melanoma in a first-degree relative or the presence of numerous melanotic nevi, which may be familial or sporadic, greatly increases the risk of developing malignant melanoma.2–4 Persons with fair or freckled skin that does not tan are at increased risk. Early identification and evaluation of skin lesions is of great clinical significance, but the disproportionate dermatologist-patient ratio poses significant problem in most developing nations. Garrod DR, Up to 5% of normal patients may exhibit this sign, which is a form of physical urticaria. Cohen S. Circular, elevated, solid lesion, >1cm . If more skin disease images are available in the future, the database of this study can be more complete. O'Doherty CJ, This site complies with the HONcode standard for trustworthy health information:   Surgical margins for excision of primary cutaneous melanoma. et al. Around 5 million new cases of skin cancer are recorded in the United States annually. If you know what to look for, you can spot warning signs of skin cancer early. Vesicle containing pus (inflammatory Identifying skin lesions and when they need treating. Kopf AW. 1997;73:356–61. Serpiginous lesions have linear, branched, and curving elements. Lavergne D, Text: Miiskin. Clark DP. Railan D, Greene MH, The border of the lesion may be scaly or have small blisters. Shingles (Herpes Zoster) A rash of raised dots that turns into painful blisters, shingles causes your … Click the lesion icons to read definitions of morphologic terms and view examples. DeSpain J, The configuration (the form or structure) is the secondary morphology. It is always found on skin that has received heavy exposure to sunlight.9,10 Actinic keratosis should be sought during routine inspection of the skin, especially in fair-skinned patients who have been exposed to sunlight frequently. Shades of blue, silver, and gray can result from deposition of drugs or metals in the skin, including minocycline, amiodarone, and silver (argyria). Cutis. verify here. Black skin lesions may be melanocytic, including nevi and melanoma. Ulcerating squamous cell carcinoma of the lip. Configuration is the shape of single lesions and the arrangement of clusters of lesions. Green fingernails suggest Pseudomonas aeruginosa infection. The typical wheal lasts < 24 hours. Pruritus sometimes occurs with atopic dermatitis, pityriasis rosea, erythema infectiosum, molluscum co… Mackie RM, Purpura is a larger area of hemorrhage that may be palpable. In: A manual of skin diseases. Have a health question or concern? Ultraviolet light from sunlight is most often a contributing factor. Primary skin lesion s are basic and simple. A patch is a large macule. Papules are elevated lesions usually < 10 mm in diameter that can be felt or palpated. Butterfly Rash (Malar Rash) Butterfly or malar rash is a kind of acute cutaneous lupus, according to … The role of treatment of actinic keratoses in the prevention of morbidity and mortality due to squamous cell carcinoma. Skin biopsies are frequently undertaken to investigate or remove a range of lesions. Sagebiel RW, 4(September 15, 1998) Skin Lesion Reference Guide Bulla Circumscribed collection of free fluid, >1 cm Macule Circular flat discoloration, <1 cm brown, blue, red or hypopigmented . Nelson BR, Clin Plast Surg. Patients who develop squamous cell carcinoma and malignant melanoma often have recognizable precursor conditions. South Med J. Swerdlow AJ, The growing edges become more irregular, and the shape becomes uneven. Examples include some fungal and parasitic infections (eg, cutaneous larva migrans). The lesions are small, darkly pigmented papules that are harmless and generally don’t require treatment. Patients who develop squamous cell carcinoma and malignant melanoma often have recognizable precursor conditions. Cancer. Actinic cheilitis is a condition that is similar to actinic keratitis but occurs on the vermilion of the lips. Crusting can occur in inflammatory or infectious skin diseases (eg, impetigo). Therefore, a computer-assisted system for quantitative colour identification is highly desirable for dermatologists to use. English J, Shriner DL, A patch is a large macule. Although few patterns are pathognomonic, some are consistent with certain diseases. Have a health question or concern? Primary neoplastic disease of the skin is common. All suspicious lesions should be excised down to a connective tissue base with a 2- to 3-mm lateral margin.15, If a cosmetically acceptable result would be difficult to obtain after excisional biopsy, full skin thickness punch biopsy of several areas may be performed, including the margins and any raised areas. Lentigo maligna (melanotic freckle of Hutchison) occurs on the face or other sun-exposed skin of older, fair-skinned persons. Mohs FE, Clinically recognized dysplastic nevi. Roberson JK. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. All other pigmented lesions that occur in these patients should be observed for change at least annually. This technique permits complete excision without excessively large margins.17,18. In black patients, the palms of the hands, soles of the feet and periungual areas are particularly vulnerable. Human papillomavirus infection may be a precursor of keratoacanthoma and periungual, genital and other squamous cell carcinomas, especially in immunosuppressed patients.8 The affected area develops a slight redness, scaling, fissuring and an uneven surface. Figures 1,3,5,7,8,10–12,15–22, and 24–27 from the Division of Dermatology, Department of Medicine, University of Texas Health Science Center, San Antonio, Tex. Examples include granuloma annulare, some drug eruptions, some dermatophyte infections (eg, tinea [ringworm]), and secondary syphilis. Friedman RJ, Metastatic basal cell carcinoma. Different Kinds of Lesions. The base is also invasive and gradually erodes the underlying tissue, making it difficult to excise the lesion completely. 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