MORPHOLOGY OF SKIN LESION

Department of Dermatovenereology
Faculty of Medicine Padjadjaran
University
 “Who studies skin diseases and fails to study
the lesion first will never learn dermatology.”
Siemens (1891–1969)
RECOMMENDED TOOLS FOR THE COMPLETE
SKIN EXAMINATION
Essential tools
• Physician eyes and hands

Recommended tools
 Magnifying tools: loops,  Alcohol pads
dermoscopy  Gauze pads
 Focused light: flashlight  Gloves
 Ruler  Scalpel blades
 Glass slide: diascopy  Wood’s lamp
 Camera
 Variation and ambiguity in the morphologic terms generally
accepted by the international dermatology community

Barriers to communication among physicians-dermatologists.

Dermatology Lexicon Project

SKIN LESION
• Primary skin lesion
• Flat
• Elevated
• Depressed

• Secondary skin lesion

• Specialized skin lesion

PRIMARY SKIN LESION
FLAT LESION
MACULE-PATCH (Latin: macula, “spot”)
• Flat, even with the surface level of the surrounding skin, without
elevation or depression, and perceptible only as an area color
different from the sorrounding skin or mucous membrane
FLAT LESION
ERYTHEMATOUS MACULE-
PATCH Macule
• Blanchable pink to red color
of skin or mucous membrane
that due to dilatation of
arteries and veins in the
papilary and reticular dermis.
• Pressure of a glass slide
( diascopy) diferentiated
from extravasated red blood
cell (purpura)
RAISED LESION
PAPULE (Latin: papula )
• Superficial, solid,
elevated lesion less
than 0.5 cm in size in
which a significant
portion projects above the
plane of the surrounding
skin.
RAISED LESION
PLAQUE
• Solid, plateu-like elevated
lesion that occupies a
relatively large surface
area in comparison with its
height above normal skin
level and has a diameter
larger than 0,5 cm.
RAISED LESION
NODULE
• Solid, round or ellipsoidal,
palpable lesion that has a
diameter larger than 0,5cm
• Main consideration: dept
of involvement and
substantive ppalpability,
rather than diameter
• Main type: epidermal,
epidermal-dermal, dermal,
dermal-subepidermal,
subcutaneus
RAISED LESION
WHEAL (Hives, Urticaria)
• Swelling of the skin
• Characteristic:
evanescent, disappearing
within 24-48 hours.
• Result of edema produced
by the escape of plasma
through vessel walls in the
upper portion of the dermis
RAISED LESION
VESICLE-BULLA
• Vesicle (<0.5cm), bulla
(>0.5cm)
• Circumsribed, elevated,
superficial cavity
containing fluid.
• Often transparent
RAISED LESION
PUSTULE
• Circumscribed, superficial
cavity of the skin that
contains purulent exudate.
SECONDARY SKIN LESION
RAISED LESION

LICHENIFICATION
• Thickened skin with accentuated
marking, resemble tree bark.
• Induce by repeated rubbing of the
skin
SCALES (Latin: squama )
• Flakes of stratum corneum
DEPRESSED LESION
EROSION
• Moist, circumsribed,
depressed lesion that
result from loss of a
portion or all of the viable
epidermal or mucosal
epithelium
• Red and ooze, but no
bleeding
DEPRESSED LESION
EXCORIATION
• Defect in which the
epidermis the upper
dermis have been
destroyed
• Result pinpoint bleeding
DEPRESSED LESION
ULCERS
• Defect depper than
excoriation, heal with
scarring
• Characteristic including:
borders, base, and
sorroiunding skin
DEPRESSED LESION
FISSURE
• Linear loss of continuity of
the skin’s surface or
mucosa that result from
excessive tension or
decreased elasticity of the
involved tissue
RAISED LESION
CRUST (Latin: crusta )
• Hardened deposits that
result when serum, blood, or
purulent exudate dries on the
surface of the skin

• Serous: yellow-brown,
• Purulent: turbid yellowish-
green
• Hemorrhagic: reddish-black
RAISED LESION
SCAR
• Proliferation of fibrous tissue
that replaces peviously normal
collagen after a wound or
ulceration breaches the
raticular dermis.
• Characteristic: deeper pink, red
color hypo/hyperpigmented.
Wrinkled appearance at the
surface, absent of adnexal
stucture
DEPRESSED LESION
ATROPHY
• Diminution in the size of
cell, tissue, organ, or part
of the body
• Appear glossy, almost
transparent, paper thin,
and wrinkled, may not
retain normal skin line
DEPRESSED LESION
SINUS
• Tract connecting deep
suppurative cavities
DEPRESSED LESION
STRIAE
• Linear deppresions of the
skin that usually measure
several centimeters in
length and result from
changes to the reticular
colagen that occur with
rapid streching of the skin.
SPECIALIZED SKIN LESION
COMEDO
• Hair folicle infundibulum that
is dilated and plugged by
keratin and lipids.
• Open comedo “black head”:
pilocebaceous unit open to
the surface of the skin with
visible keratinaceous plug.
• Closed comedo:
infundibulum closed,
follicular opening unapparent
TELANGIECTASIA
• Persistent dilatation of the small capilaries in the superficial
dermis that are visible as fine, bright, nonpulsatile red lines ot
net like patterns on the skin
BURROW
• Wavy, threadlike tunnel through the outer portion of the
epidermis excavated by parasite
CYST
• Sac containing liquid or
semisolid materials and
may be superficial or deep
SHAPE OR CONFIGURATION OF SKIN
LESION
ANULAR
• Ring-shaped; edge of the lesion differs from the center
ROUND/NUMMULAR/DISCOID
• Coin-shaped; uniform morphology from the edge to center
RETICULAR
• Net-like or lacy in appearance, with somewhat regulary
spaced rings or partial rigs and sparing of intervening skin
SERPIGINOUS
• Serpentine or snake-like
WHORLED
• Like marble cake, with two distinct colors interspersed in a
wavy pattern
POLYCYCLIC
• Coalescing circles, rings, or incompleted rings
ARCUATE
• Arc-shaped, incomplete formation of annular lesion

LINEAR
• Resembling a straight line

TARGETOID
• Target-like, with at least three distinct zones
ARRANGEMENT OF MULTIPLES SKIN
LESION
GROUPED/HERPETIFORM SCATTERED
• Lesions clustered together • Irregulary distributed
DISTRIBUTION OF MULTIPLES SKIN
LESION
Dermatomal/zosteriform
• Unilateral and lying in the distribution of a single spinal
afferent root
Blaschkoid
• Following lines of skin cell migration during embriogenesis
Lymphangitic
• Lying along distribution of a lymp vessel
Sun exposed
• Occuring in areas usually not covered by clothing
Sun protected
• Occuring in areas usually covered by clothing
Acral
• Occuring in distal locations
Truncal
• Occuring on the trunk or central body
Extensor
• Occuring in the distal locations
Flexor
• Overlying the flexor muscles of the ectremities
Intertriginous
• Occuring in the skin fold
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