Morphology and Differential Diagnosis

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Morphology and Differential Diagnosis
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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.

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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.

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Macule
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Macule
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Macule
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Patch
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Papule
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Papules
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Papules
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Papules
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Plaque
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Plaque
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Plaque
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Nodule
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Nodule
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Nodule
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Tumor
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Tumor
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Tumor
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Pustule
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Pustule
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Vesicle
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Vesicle
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Vesicle
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Bulla
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Bulla
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Wheals
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Wheals
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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

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Burrow
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Comedone
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Telangiectasia
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Cyst
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Secondary Lesions

• Scale
• Crust
• Erosions and ulcers
• Excoriations
• Fissures
• Scars
• Lichenification
• Atrophy

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Scales
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Scales
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Scales
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Crust
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Crust
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Excoriations
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Erosion
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Erosion
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Ulcer
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Ulcer
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Ulcer
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Fissure
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Fissure
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Atrophy
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Atrophy
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Atrophy
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Atrophy
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Scar
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Lichenification
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Configuration

• Annular
• Arcuate
• Geographic
• Discrete
• Confluent
• Serpiginous

• Linear
• Reticulated

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Annular and arcuate
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Linear
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Erythema Subitum
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Descriptors

• Punctate
• Lichenoid
• Umbilicated
• Scarletiniform, morbiliform
• Leonine

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Color

• Pink
• Violet
• Orange
• Blue
• Green
• Yellow
• Black
• Brown

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Color

• PinkPityriasis rosea
• VioletLichen planus
• OrangeJuvenile xanthogranuloma
• BlueAmioderone skin pigmentation
• GreenPseudomonas
• YellowXanthomas
• Blackeschar
• BrownCafé au lait spots

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Color
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Distribution
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Morphologic categories

• Macular-Patch
• Papular
• Papulosquamous (scaly papules)
• Nodular
• Pustular
• Vesicular-bullous

• Urticarial
• Petechial
• Telangiectatis
• Burrow
• Poikiloderma
• Hyperkeratotic/scale
• Atrophic

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More is missed by not looking than by not
knowingM. McKay, M.D.
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Procedures

• Liquid Nitrogen
• Electrodessication and curettage
• Biopsy
• Punch
• Shave
• Excision

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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

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Dermatosis Papulosa Nigra

• Most likely a subtype of seborrheic keratosis
• Malar areas, most commonly on African-American
  women

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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

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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

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Dermatofibroma
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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 African-Americans
• Treatment can be difficult and choices include
  intralesional steroids, radiation, careful
  excision, laser ablation

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Epidermoid Cyst
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Trichilemmal (Pilar) Cyst
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Actinic Keratosis
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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

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Keratosis Pilaris
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Keratosis Pilaris
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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

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