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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
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 dont use this term with patients Usually appear on trunk, start at age 30, increase with age Dilated capillaries Tx for cosmetic reasons only
