MORPHOLOGIC LESIONS

1. RAISED LESION
a. Papule

=asolid,
0,5cmin
projects
lighting
darkened
detect
with
Sessile,
shaped,
smooth,
some
surfaces
shape :
b. Plaque

elevated lesion less than

size which a significant
above the plane of the
surroundingskin.Oblique
with a flashlight in a
roomisoftennecessaryto
slight elevation. Papules
scaling are referred to as
papulosquamous lesions.
pedunculated, dome
flat topped, rough,
filiform, mammillated,
acuminate,

and
umbilicated constitute
common shapes and
of papules. Clinical
lichenplanus

= a solid plateau-like elevation that occupies a relatively large surface

area in comparison with its height above the normal skin level and has
a diameter larger than 0,5 cm. Plaques may form by
extension/confluence of papules. Clinical shape : psoriasis

c. Nodule

= nodule is a palpable, solid, round or ellipsoidal lesion. Depth of

involvement and/or substantive palpability, rather than diameter,
differentiate a nodule from a papule. Depending upon the anatomic
component(s) primarily involved, nodules are of five main types: (1)
epidermal, (2) epidermal-dermal, (3) dermal, (4) dermal-subdermal,
and (5) subcutaneous. Clinical example : Basal Cell Carcinoma
Tumor the heading of nodule, mass, benign/malignant
Gumma granulomatous nodule lesion of tertiary syphilis
d. Cyst

=
an
encapsulated
cavity/sac lined with a true epithelium that contains fluid or semisolid
material (cells and keratin). Cyst may be hard, doughy, or fluctuant.
Clinical example : Cystic Hidradenoma
e. Wheal

= a swealing of the skin

that is characteristically evanescent, disappearing within hours. Also
known as hives, urticaria edema produced by the escape of plasma
through vessel walls in the upper portion of the dermis. Wheals may be
tiny papules 2-4mm or giant papules greater than 10mm. Wheals can
be seen as an allergic response to innumerable initiating agents, such
as drugs and insect bites. Wheal-like lesions occur occasionally in
dermatitis herpetiformis and bullous pemphigoid. The wheal produced
in response to the stroking of a reddish-brown or brownish macule
(Darier's
sign)
is
pathognomonic
of
urticaria
pigmentosa
(mastocytosis). Stroking of the skin may produce wheals in some
normal persons; this phenomenon is called dermographism, classified
as one of the physical urticarias.

f. Scar

= arises from proliferation of fibrous tissue that replaces previously

normal collagen after a wound or ulceration breaches the reticular
dermis. Deeper pink to red color early in before hypo/hyperpigmented.
Hypertrophic scars firm papules, plaques, nodules. Keloid scars
elevated. Atrophic scars depressed plaques.
g. Comedo

= hair follicle infundibulum that is dilated and plugged by keratin and

lipids. Pilosebaceous inits open the surface of the skin with a visible
keratinaceous plug open comedo. The black color oxidized
sebaceous content of the infundibulum (blackhead). Closed
infundibulum in which the folliculalr opening is unapparent

accumulates whitish keratin closed comedo. Clinical example :

comedomal acne
h. Horn

= a conical mass cornified cells arising over an abnormally

differentiating epidermis. HPV replication in keratinocytes of a wart or
the clonal expansion of mutated keratinocytes in squamous cell
carcinoma. Clinical example : verruca vulgaris
i. Calcinosis

= deposits of calcium in the

dermis or subcutaneous
tissue may be appreciated
as hard, whitish nodules or
plaques, with or without
visible alteration of the skins surface. Clinical example : cutaneous
calcinosis in dermatomyositis
2. DEPRESSED LESION
a. Erosion

= a moist, circumscribed, depressed lesion that results from loss of a

portion or all of the viable epidermal or mucosal epithelium. Clinical
example : TEN
b. Ulcers

= a defect in which the epidermis and at least upper (papillary dermis)

has been removed. Clinical example : pyoderma gangrenosum
c. Atrophy

= a diminution iin the size of a cell, tissue, organ, or part of the body.
Decrease number of epidermal cells thinning of the epidermis.
d. Poikiloderma

= combination of atrophy, telangiectasis, and varied pigmentary

change over an area of the skin. Clinical example : chronic
radiodermatitis
e. Sinus

= a tract connecting deep suppurative cavities to each other or to the

surface of the skin. Contents of the cabity : pus, fluid, keratin, drain to
the surface. Clinical example : hidradenitis suppurativa
f. Striae

= linear depressions of the skin that usually measure several

centimeters in length and result from changes to the reticular collagen

that occur with rapid stretching of the skin. Clinical example : striae
distensae
g. Burrow

= wavy, threadlike tunnel

through the outer portion of
the epidermis excavated by a
parasite, few millimeters in length. Clinical example : scabetic burrow
h. Sclerosis

= circumscribed or diffuse hardening or induration in the skin that is a

result of dermalfibrosis. Clinical example : morphea

3. FLAT LESION
a. Macule

= flat lesion, even with the surface level of surrounding skin,

perceptible as an area of color different from the surrounding skin or
mucous membrane. Clinical example : lentigo

b. Erythema

= blancable change in color of skin or mucous membrane that is due to

dilatation of arteries and veins in the papillary and reticular dermis.
Clinical example : fixed drug eruption
c. Patch
= similar to macule, flat area of skin or mucous membrane
with a different color from its surrounding. Clinical example :
vitiligo
d. Erythroderma

= generalized deep redness of the skin involving more than 90 percent

of the body surface within days to weeks. Clinical example : sezary
syndrome
4. SURFACE CHANGE
a. Scale, Desquamation (Scaling)

= flat plate or flake arising from the outer most layer of the stratum
corneum. Clinical example : psoriasis vulgaris
b. Crusts (encrusted exudates)

= hardened deposits that results when serum, blood, or purulent

exudate dries on the surface of the skin. Clinical example : impetigo
c. Excoriations

= surface excavations of epidermis that results from scratching and

are frequent finding in patients experiencing pruritus.
d. Fissure

= a linear loss continuity of the skins surface or mucosa that results

from excessive tension or decreased elasticity of the involved tissue.
Clinical example : fissure on the palm associated with contact
dermatitis
e. Lichenification

= repeated rubbing of the skin may induce a reactive thickening of the

epidermis, with changes in the collagen of the underlying superficial
dermis. Clinical example : LSC
f. Keratoderma

= excessibe hyperkeratosis of the stratum corneum that results in a

yellowish thickening of the skin usally on the palms or soles that may

be inherited (abnormal keratin formation) or acquired (mechanical

stimulation). Clinical example : plantar keratoderma
g. Eschar

= tissue necrosis, infacrction, deep burns, gangrene, or other

ulcerating process. Clinical example : thermal burn
5. FLUID FILLED
a. Vesicle and Bulla

Vesicle : fluid filled cavity or elevation smaller than or equal to

0,5 cm. clinical example : toxin producing staphylococcal
impetigo
Bulla (blister) : measures larger than 0,5 cm. clinical example : a
bullous pemphigoid
b. Pustule

= a circumscribed, raised cavity in the epidermis or infundibulum

containing pus. Clinical example : superficial pyoderma
c. Furuncle

= a deep necrotizing folliculitis with suppuration. Several furncle may

coalesce to form a carbuncle.
d. Abscess

= a localized accumulation of purulent material so deep in the dermis

or subcutaneous tissue that the pus is usually not visible on the
surface of the skin. Clinical example : folliculitis resulting from
streptococcal or staphylococcal infection
6. VASCULAR
a. Purpura

= extravasation of blood from cutaneous vessles into

skin/mucous membrane results in reddish purple lesions.

Diascopy differentiate between erythema and purpura.

Redness is non-blanching under the pressure of the slide
purpuric lesion. Clinical example : leukocytoclastic vasculitis.
b. Telangiectasia

= persistent dilatations of small capillaries in the superficial

dermis that are visible as fine, bright, non pulsatile red lines
or net like patterns on skin not disappear with diascopy.
c. Infarct

= area of cutaneous necrosis resulting from a bland or inflammatory

occlusion of blood vessels in the skin. Tender, irregularly shaped dusky
reddish fray macule or firm plaque that is sometimes depressed
slightly below the plane of the skin. Clinical example : cholesterol
emboli