• Macule - flat, colored lesion that may be white, brown, or red. • Cyst - A nodule filled with either liquid or semisolid material. • Plaque - lesion greater than cm in diameter. Example: Macule, papule, patch, plaque, vesicle, bulla, A cyst may have an epithelial or endothelial lining. Example: Epidermal inclusion cyst. FURUNCLE - An acute, round, firm, circumscribed, follicle-centered nodule caused by infection that is usually greater than 10 mm in diameter. Characterized by pain, redness, and potentially visible pus.
This maculs a corrected version of the article that appeared in print. Patients will experience a wide range of skin growths and changes over their lifetime. Family what does a water pill do for high blood pressure should be differene to distinguish potentially malignant from benign skin tumors. Most lesions can be diagnosed on the basis of history and clinical examination. Lesions that are suspicious for malignancy, those with changing characteristics, symptomatic lesions, and those that cause cosmetic problems may warrant medical therapy, a simple office procedure e.
Acrochordons are extremely common, small, and typically pedunculated benign neoplasms. Simple scissor or shave excision, electrodesiccation, or cryosurgery can be used for treatment.
Sebaceous hyperplasia presents as asymptomatic, discrete, soft, pale yellow, shiny bumps on the forehead or cheeks, or near hair follicles. Except for cosmesis, they have no clinical significance. Lipomas are soft, flesh-colored nodules that are what are the best exercises for saddlebags moveable under the overlying skin. Keratoacanthomas are rapidly growing, squamoproliferative benign tumors that resemble squamous cell carcinomas.
Early simple excision is recommended. Pyogenic granuloma is a rapidly growing nodule that bleeds easily. Treatment includes laser ablation or shave excision with electrodesiccation of the base. Dermatofibromas are an idiopathic benign proliferation of fibroblasts. No treatment is required unless there is a change in size or color, bleeding, or irritation from trauma. Epidermal inclusion cysts can be treated by simple excision with removal of the cyst and cyst wall.
Seborrheic keratoses and cherry angiomas generally do not require treatment. Skin problems are commonly encountered in primary care. One retrospective chart review of dermatology referrals at a university general medicine clinic betweeb that approximately one-third of amcule were referred during their initial visit to their primary care physician.
Enlarge Print. Ultrasonography can aid in the diagnosis of lipomas. High-frequency ultrasonography i. Diagnosis of macu,e is based on the characteristic appearance and dimpling or retraction of the lesion beneath the skin with lateral compression.
Intralesional steroid injection with interval excision can hasten resolution of inflamed epidermal inclusion cysts. Clinicians must take special precautions in evaluating skin tumors and screening for skin cancer.
The use of dermoscopy to improve diagnosis has been addressed in a previous article in American Family Physician. This article will review some common benign skin tumors that are amenable to office procedures, as well as those that may require referral Table 1. Cryosurgery should be performed with caution in persons with darker skin; refer patients with eyelid involvement.
Firm, raised, tan to reddish-brown papules or nodules; dimpling with lateral compression. Abrupt appearance of multiple lesions may occur in persons with human immunodeficiency virus infection or systemic lupus erythematosus. Refer patients with cellular variant and dermatofibrosarcoma protuberans deep invasion and metastases. Firm, mobile, subcutaneous nodule with central punctum; painless unless inflamed. Excision, intralesional steroid injection with interval excision for inflamed cysts.
Presence of punctum helps differentiate cysts from lipomas; history helps differentiate between inflamed cyst and abscess acute. Inflamed cysts and those that have undergone previous incision and drainage can be more difficult to excise; refer patients with facial cysts.
Excision, intralesional injection methotrexate, fluorouracil, bleomycinMohs micrographic surgery. Rapidly growing, yellow to violaceous, friable nodule, often surrounded by scaly collarette. Amelanotic melanoma, Spitz berween, basal cell carcinoma, squamous cell carcinoma. Dome-shaped papule with central umbilication and uniform yellow lobules on magnification. Chemical cautery, cryosurgery, electrodesiccation, laser ablation, oral isotretinoin, phototherapy, shave excision.
Acrochordons skin tags are extremely common, small, and typically pedunculated benign neoplasms. They consist of hyperplastic soft dermis and epidermis, and are usually skin colored or brownish Figure 1. They are generally 2 to 5 mm in size, although they may become larger. The most common locations are in skin folds e. Diagnosis is based on the appearance and location of lesions.
They must be differentiated from neurofibromas, seborrheic keratoses, and pedunculated nevi. There have been rare case reports of skin tags that were found to be basal or squamous cell carcinomas.
Treatment consists beteen cryosurgery, electrodesiccation, or simple scissor or shave excision. Electrodesiccation causes less hypopigmentation than cryotherapy and is the preferred treatment in nonwhite patients.
An ear speculum placed over a small lesion may be helpful in directing the freeze pattern during cryosurgery. Sebaceous hyperplasia is a benign disorder of the sebaceous glands that is common in middle-aged or older adults.
Lesions present as asymptomatic, discrete, shat, pale yellow, shiny bumps on the forehead Figure 2 or cheeks, or near hair follicles. They typically appear as an umbilicated dome with multiple lobules resembling a cauliflower. There may be single or multiple lesions, ranging from 1 to 4 mm in diameter.
They have no clinical significance except for cosmesis. Histologically, lesions consist of between mature lobules of sebocytes around a central duct. It is important to rule out basal cell carcinoma, which is generally red or pink and increasing in size. Inspection of any surface vessels will show a haphazard arrangement in basal cell carcinoma, whereas the vessels in sebaceous hyperplasia occur only between lobules.
Sebaceous hyperplasia on the forehead with the typical umbilicated, lobulated appearance without wuat blood vessels. No treatment is required for sebaceous hyperplasia, although patients may request removal of lesions for cosmetic reasons or because of concerns about malignancy. Therapeutic options include cryosurgery, phototherapy, shave excision, laser ablation, electrodesiccation with curettage, chemical cautery, or oral isotretinoin for widespread lesions. Lipomas are slow-growing, benign mesenchymal tumors enclosed by a how to recover corrupted mmc fibrous capsule.
They closely resemble normal fat and are the most common type of soft tissue tumor. They are usually subcutaneous but may occur in any organ because they are mesenchymal. They are generally asymptomatic but may become irritated with trauma or produce local obstructive symptoms in the airway or gastrointestinal tract.
Lipomas must be clinically differentiated from other tumors. The primary differential diagnosis in a subcutaneous mass is a sebaceous cyst or abscess. Sebaceous cysts are generally identifiable by a central punctum, and abscesses can be identified by the presence of warmth, redness, and pain.
Ultrasonography is increasingly used to aid in the diagnosis of lipomas. High-frequency ultrasonography greater than 20 MHz can provide high-resolution images of subcutaneous tumors and surrounding structures. Lesions concerning for malignancy should be imaged with computed mavule or contrast magnetic resonance imaging. Patients commonly present with cosmetic concerns or symptoms related to compression of surrounding tissue.
A single incision or punch excision for smaller lesions will generally allow manual expression of the lipoma without difficulty when standard excision is not required. Keratoacanthomas are rapidly growing, squamoproliferative benign tumors that resemble squamous cell carcinoma.
They may grow to 1 to 2 cm over weeks or months. There is a slower involution phase over several months, leaving a scar if not excised early in its course. Keratoacanthomas generally occur later in bdtween on sun-exposed areas, primarily the face, arms, and legs.
They are attributed to sun exposure, cigarette smoking, human papillomavirus infection, genetic factors, trauma, and chemical carcinogens. Typical dome-shaped, keratin-filled plug differrnce a keratoacanthoma on the dorsal arm. There is long-standing controversy over whether keratoacanthomas are benign, spontaneously self-limited tumors or a variant of cutaneous squamous cell carcinoma that have the potential for metastasis. Shave biopsy may be inadequate to how much is kirkland toilet paper at costco the conditions, qhat punch biopsy may be adequate because it obtains deeper tissue.
Because no clinical or pathologic features can reliably differentiate keratoacanthoma from squamous cell carcinoma, early simple excision of lesions is recommended, with margins of 3 to 5 mm. Mohs micrographic surgery may be considered if tissue sparing is desired. Medical treatment systemic retinoids or intralesional injections of methotrexate, fluorouracil, or bleomycin is reserved for nonsurgical candidates, patients with multiple lesions, and those with lesions on inoperable sites.
Pyogenic granulomas are rapidly growing nodules that bleed easily. Their name is a misnomer, however, as these lesions are neither pyogenic nor granulomas. They are an acquired benign tumor often found on mucous membranes. They tend to occur on the head or neck, or at sites of previous penetrating trauma. Pyogenic granulomas are yellow to purplish, pulpy vascular lesions often surrounded by a scaly collarette.
They are cyt removed because of their rapid growth and tendency to bleed. The differential diagnosis includes Spitz nevi, amelanotic melanoma, and squamous or basal cell carcinoma. Treatment options include shave excision with electrodesiccation of the base, and laser ablation 18 Figure 4. A red, nodular pyogenic granuloma A before treatment, and B after laser ablation.
Dermatofibromas result from idiopathic benign proliferation of fibroblasts. Generally located on the lower extremities, they may develop at any cutaneous site and range in size from 3 to 10 mm. They are four times more common in women, and most develop between 20 and 50 years of age. Dermatofibromas appear gradually over months and may persist for years.
1. Macule: Macules are circumscribed alterations in skin color. The skin surface is neither elevated or depressed in relation to the surrounding skin. Macules may be of any size or color. A macule greater than 2 cm. in diameter is called a patch. Ex: cafe-au-lait: Mongolian spot; freckle mybajaguide.com Size: 51KB. Oct 01, · The primary differential diagnosis in a subcutaneous mass is a sebaceous cyst or abscess. Lipomas are soft, flesh-colored nodules that are easily moveable under the overlying skin. Sebaceous cysts.
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. Location and distribution. Macules represent a change in color and are not raised or depressed compared to the skin surface.
A patch is a large macule. Examples include freckles, flat moles, tattoos, and port-wine stains , and the rashes of rickettsial infections , rubella , measles can also have papules and plaques , and some allergic drug eruptions.
Examples include nevi, warts, lichen planus , insect bites, seborrheic keratoses , actinic keratoses , some lesions of acne , and skin cancers. The term maculopapular is often loosely and improperly used to describe many red rashes; because this term is nonspecific and easily misused, it should be avoided. Plaques may be flat topped or rounded.
Lesions of psoriasis and granuloma annulare commonly form plaques. Nodules are firm papules or lesions that extend into the dermis or subcutaneous tissue. Examples include cysts , lipomas , and fibromas. Vesicles are characteristic of herpes infections, acute allergic contact dermatitis , and some autoimmune blistering disorders eg, dermatitis herpetiformis. These may be caused by burns, bites, irritant contact dermatitis or allergic contact dermatitis , and drug reactions.
Classic autoimmune bullous diseases include pemphigus vulgaris and bullous pemphigoid. Bullae also may occur in inherited disorders of skin fragility. Pustules are vesicles that contain pus. Pustules are common in bacterial infections and folliculitis and may arise in some inflammatory disorders including pustular psoriasis.
Urticaria wheals or hives is characterized by elevated lesions caused by localized edema. Wheals are pruritic and red. Wheals are a common manifestation of hypersensitivity to drugs, stings or bites, autoimmunity, and, less commonly, physical stimuli including temperature, pressure, and sunlight. Scale is heaped-up accumulations of horny epithelium that occur in disorders such as psoriasis , seborrheic dermatitis , and fungal infections.
Pityriasis rosea and chronic dermatitis of any type may be scaly. Crusts scabs consist of dried serum, blood, or pus. Crusting can occur in inflammatory or infectious skin diseases eg, impetigo. Erosions are open areas of skin that result from loss of part or all of the epidermis. Erosions can be traumatic or can occur with various inflammatory or infectious skin diseases. An excoriation is a linear erosion caused by scratching, rubbing, or picking.
Ulcers result from loss of the epidermis and at least part of the dermis. Causes include venous stasis dermatitis , physical trauma with or without vascular compromise eg, caused by decubitus ulcers or peripheral arterial disease , infections, and vasculitis. Petechiae are nonblanchable punctate foci of hemorrhage. Causes include platelet abnormalities eg, thrombocytopenia, platelet dysfunction , vasculitis , and infections eg, meningococcemia, Rocky Mountain spotted fever , other rickettsioses.
Purpura is a larger area of hemorrhage that may be palpable. Palpable purpura is considered the hallmark of leukocytoclastic vasculitis. Purpura may indicate a coagulopathy. Large areas of purpura may be called ecchymoses or, colloquially, bruises.
Atrophy is thinning of the skin, which may appear dry and wrinkled, resembling cigarette paper. Atrophy may be caused by chronic sun exposure, aging, and some inflammatory and neoplastic skin diseases, including cutaneous T-cell lymphoma and lupus erythematosus.
Atrophy also may result from long-term use of potent topical corticosteroids. Scars are areas of fibrosis that replace normal skin after injury.
Some scars become hypertrophic or thickened and raised. Keloids are hypertrophic scars that extend beyond the original wound margin. 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.
Linear lesions take on the shape of a straight line and are suggestive of some forms of contact dermatitis , linear epidermal nevi, and lichen striatus. Traumatically induced lesions, including excoriations caused by the patient's fingernails, are typically linear. Annular lesions are rings with central clearing. Examples include granuloma annulare , some drug eruptions, some dermatophyte infections eg, tinea [ringworm] , and secondary syphilis.
Nummular lesions are circular or coin-shaped; an example is nummular eczema. Serpiginous lesions have linear, branched, and curving elements.
Examples include some fungal and parasitic infections eg, cutaneous larva migrans. Reticulated lesions have a lacy or networked pattern. Examples include cutis marmorata and livedo reticularis.
Herpetiform describes grouped papules or vesicles arranged like those of a herpes simplex infection. Zosteriform describes lesions clustered in a dermatomal distribution similar to those of herpes zoster. Verrucous lesions have an irregular, pebbly, or rough surface. Examples include warts and seborrheic keratoses. Lichenification is thickening of the skin with accentuation of normal skin markings; it results from repeated scratching or rubbing.
Induration, or deep thickening of the skin, can result from edema, inflammation, or infiltration, including by cancer.
Indurated skin has a hard, resistant feeling. Induration is characteristic of panniculitis , some skin infections, and cutaneous metastatic cancers. Umbilicated lesions have a central indentation and are usually viral.
Examples include molluscum contagiosum and herpes simplex. Xanthomas, which are yellowish, waxy lesions, may be idiopathic or may occur in patients who have lipid disorders. Psoriasis frequently affects the scalp, extensor surfaces of the elbows and knees, umbilicus, and the gluteal cleft. Lichen planus frequently arises on the wrists, forearms, genitals, and lower legs. Vitiligo may be patchy and isolated or may group around the distal extremities and face, particularly around the eyes and mouth.
Discoid lupus erythematosus has characteristic lesions on sun-exposed skin of the face, especially the forehead, nose, and the conchal bowl of the ear. Hidradenitis suppurativa involves skin containing a high density of apocrine glands, including the axillae, groin, and under the breasts. Red skin erythema can result from many different inflammatory or infectious diseases. Cutaneous tumors are often pink or red. Superficial vascular lesions such as port-wine stains may appear red.
Orange skin is most often seen in hypercarotenemia, a usually benign condition of carotene deposition after excess dietary ingestion of beta-carotene. Yellow skin is typical of jaundice , xanthelasmas and xanthomas, and pseudoxanthoma elasticum.
Green fingernails suggest Pseudomonas aeruginosa infection. Violet skin may result from cutaneous hemorrhage or vasculitis.
Vascular lesions or tumors, such as Kaposi sarcoma and hemangiomas, can appear purple. A lilac color of the eyelids or heliotrope eruption is characteristic of dermatomyositis. Shades of blue, silver, and gray can result from deposition of drugs or metals in the skin, including minocycline , amiodarone , and silver argyria. Ischemic skin appears purple to gray in color. Deep dermal nevi appear blue. Black skin lesions may be melanocytic, including nevi and melanoma.
Black eschars are collections of dead skin that can arise from infarction, which may be caused by infection eg, anthrax , angioinvasive fungi including Rhizopus, meningococcemia , calciphylaxis , arterial insufficiency, or vasculitis. Dermatographism is the appearance of an urticarial wheal after focal pressure eg, stroking or scratching the skin in the distribution of the pressure.
Darier sign refers to rapid swelling of a lesion when stroked. It occurs in patients with urticaria pigmentosa or mastocytosis. Nikolsky sign is epidermal shearing that occurs with gentle lateral pressure on seemingly uninvolved skin in patients with toxic epidermal necrolysis and some autoimmune bullous diseases. Auspitz sign is the appearance of pinpoint bleeding after scale is removed from plaques in psoriasis.
Koebner phenomenon describes the development of lesions within areas of trauma eg, caused by scratching, rubbing, or injury. Psoriasis frequently exhibits this phenomenon, as may lichen planus , often resulting in linear lesions. 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.
The Merck Manual was first published in as a service to the community. Learn more about our commitment to Global Medical Knowledge. This site complies with the HONcode standard for trustworthy health information: verify here. Common Health Topics. Videos Figures Images Quizzes. Commonly Searched Drugs. Lesion Type Primary Morphology. Lesion Configuration Secondary Morphology.