1 Classic; 2 Extended; 3 See also; 4 References; Classic. Inflammation commonly leads to pigmentary changes - both lighter and darker, which may persist for a long time after the initial dermatosis has finally settled. Fissure: a sharply-defined, linear or wedge-shaped tear in the epidermis with abrupt walls, typically due to excess skin dryness. Facebook 15 Tweet Print Email. Mnemonics for the differential diagnosis of lucent/lytic bone lesions include: FEGNOMASHIC FOG MACHINES They are anagrams of each other and therefore include the same components. Adapted by Geeky Medics. Skin lesions like bruises, birthmarks, and burns can give us a clue about the condition of our health. DEPARTMENTS: Language of Dermatology. Adapted by Geeky Medics. Vesicle: a raised, clear fluid-filled lesion less than 0.5cm in diameter. Licence: Hektor. Pityriasis versicolour. Alopecia areata: well-defined patches of hair loss with surrounding normal hair. www.jcdr.net Nadia Shirazi et al., Pigmented Pre-malignant and Malignant Skin Lesions Journal of Clinical and Diagnostic Research. Abscess: a localised accumulation of pus. Those calorie counts are without butter. In an attempt to overcome the overwhelming amount of information, mnemonics are often used, and they have proven to be a successful learning aid. Click for word document: Approach to Skin Lesions Background. Describing Skin Lesions. Since skin cancers are composed of masses of cells the most consistent warning sign is the development of a persistent bump or spot in an area of sun-damaged skin. Venous ulcer. Licence: PanaromicTiger. Porphyria is a group of liver disorders in which substances called porphyrins build up in the body, negatively affecting the skin or nervous system. erythema nodosum, subcutaneous throm‐bophlebitis, cutaneous hypersensitivity), Eye lesions (e.g. Note the number, location and distribution of the patient’s skin lesions from the end of the bed: Look for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status: Assess the size of the lesion(s): measure their width and height (if raised). Describing the Distribution of Skin Lesions. Seborrhoeic dermatitis. Although mnemonics have limitations and should not replace traditional methods of teaching and learning, they are a useful education tool. How to describe a lump or mass Tenderness Site Size Surface Shape Edge Consistency Fluid thrill Pulsatility Mobility and movement with inspiration Whether you can get above the mass Click here to learn how to do a full abdominal examination and here for other medical exams Click here for medical student OSCE and PACES exam […] When assessing configuration, note the following characteristics: Discrete lesions: individual lesions, clearly separated from one another (e.g. I have not had much chance to become comfortable describing lesions (eg when requesting derm consults for patients). Purpuric lesions: reddish/purple discolouration of the skin caused by small blood vessels bleeding into the skin. Mild degrees of redness (erythema) may be masked completely. Located on the left upper neck was a well-healed linear scar, status post excision with no evidence of hyperpigmentation or overlying nodularity or evidence of skin lesions. Published in 1997. Urticaria. Describing Skin Lesions. MNEMONIC: R ice O ats C orn =o K grains with DH: MNEMONIC NOTES: Gluten containing grains: Wheat, Rye, Barley Of note: DH enteropathy is patchy so small bowel bx not always positive, but is positive in 90% of DH pts. Psoriasis. Please note that these skin lesion pictures should not be used as a means of self-diagnosis. Scalp psoriasis: plaques of psoriasis located on the scalp, often resulting in visible scale in the hair. e.g., freckles; Patch: Flat lesion > 1 cm in diameter . The challenge for GPs is in distinguishing between benign and malignant lesions, so that only those that require urgent review and treatment are referred under the 2-week wait. there are several skin lesions that are very common and benign (non-cancerous). Learn about the ABCDE assessment to detect melanoma skin cancer! Adapted by Geeky Medics. Now let’s move on to secondary lesions. Contents. Learn about the ABCDE assessment to detect melanoma skin cancer! They undergo an evolution of colour from purple to pink to white as they mature. Keratocanthoma. and you may need to create a new Wiley Online Library account. This guide provides a clear step-by-step approach to examining a skin lesion in an OSCE setting. There is nothing needed to do for these lesions other than reassure your patient. They may be skin coloured or red, pink, violaceous, brown, black, grey, blue, orange, yellow. If you'd like to support us and get something great in return, check out our PDF OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. Location and distribution (e.g. Adapted by Geeky Medics. circular, linear, annular, irregular o E dge e.g. The lesions may be hotter or cooler than surrounding skin. Learn about our remote access options. 2. They describe the physical condition and/or progression of any skin abnormality that would suggest the development of a malignancy. growth spurts, ascites, intrabdominal malignancy, Cushing’s syndrome, obesity, pregnancy). JAMA Dermatology 153: 377-378. The skin is considered to have three parts: the outer epidermis, middle dermis and deep subcutaneous tissue. Inspect the elbows for evidence of psoriasis plaques, xanthomas (hyperlipidaemia) or rheumatoid nodules (rheumatoid arthritis). Erythematous lesions: redness of the skin caused by an increased blood supply to the area. STUDY. (sometimes the secondary changes make it impossible to see and describe the primary lesion) (scale, lichenification, keloid, excoriation, fissure, erosion, ulcer, atrophy, crust, hyperkeratosis) 3. Skin lesions may be flat, elevated above the plane of the skin or depressed below the plane of the skin. grouped) Border/shape (e.g. Erythematous lesions will blanch when pressure is applied. Discoid eczema. If you are less familiar with the ... I’ve heard people use the SCALD mnemonic for describing lesions. Check your skin for new lesions or changes in the appearance of moles. Although they are benign, they exhibit some of the clinical and histologic features of malignant melanoma. To do that, you need to know how to describe a lesion with the associated language. As a result, it’s important to perform a comprehensive assessment to identify relevant pathology. Licence: Htirgan. Primary Lesions: Those lesions that are the direct result of a pathologic process 1. Four components of describing a skin lesion. Adapted by Geeky Medics. Scar. Macules are flat, nonpalpable lesions usually < 10 mm in diameter. Hyperpigmented macules: pathognomonic for Peutz-Jeghers syndrome, an autosomal dominant genetic disorder that results in the development of polyps in the gastrointestinal tract. Ask the patient if they have any pain before proceeding with the clinical examination. oral, nails, scalp), "With generalized, none of the skin is SPARED", Pityriasis alba/Post‐inflammatory hypopigmentation, Age related hypopigmentation (e.g. NOT RECLUSE N - numerous: Most recluse bites (and spider bites in general) are singular wounds where the spider will bite when being near fatality crushed between skin and some other surface. well demarcated, ill-defined o C olour e.g. Your skin is not only your largest organ but is also an integral component of the body’s defence system. Macule: a flat area of altered colour less than 1.5cm in diameter. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Acne. linear, serpiginous) Papule: a solid raised palpable lesion less than 0.5cm in diameter. Adapted by Geeky Medics. The home health nurse assessing skin lesions uses the PQRST mnemonic as a guide. Assess the symmetry of the skin lesion: asymmetry is suggestive of malignancy. Describing Lesions in Dermatology Inspect lesions Sites and size o e.g. Nodule: a solid raised palpable lesion greater than 0.5cm in diameter. Assess the elevation of the skin lesion and take a history of the lesion’s evolution: elevated skin lesions and those which have a history of bleeding and itching are more concerning for malignancy. Most skin lesions are benign though some, such as actinic keratosis and certain moles, can be a pre-cursor to a skin cancer or already a skin cancer. Striae. Licence: MediaJet. The pattern of multiple lesions or the shape of an individual lesion can be useful in narrowing the differential diagnosis. Roberta B. Oliveira, Aledir S. Pereira, João Manuel R. S. Tavares, Computational diagnosis of skin lesions from dermoscopic images using combined features, Neural Computing and Applications, 10.1007/s00521-018-3439-8, (2018). Adapted by Geeky Medics. the loss of skin color. Macules represent a change in color and are not raised or depressed compared to the skin surface. Skin lesions are a frequent presentation in general practice so it is important for clinicians to be able to distinguish benign conditions from those such as melanoma that will require urgent referral and treatment. In addition, the skin can serve as a window for the evaluation of internal health and disease. Licence: Allergy research. Number of times cited according to CrossRef: https://doi.org/10.1111/j.1365-4632.2004.02555.x. Hypomelanosis of Ito), Common Causes of Leukocytoclastic Vasculitis, Autoimmune (Systemic Lupus Erythematosus, Sjögren's syndrome, rheumatoid arthritis), Streptococci, Staphylococci, Henoch‐Schönlein purpura, Cryoglobulins, Cryofibrinogens, Churg Strauss/Wegener's granulomatosis, Ulcerative colitis, urticarial vasculitis, Lymphoproliferative disease (hairy cell leukemia), Infectious (endocarditis, meningococcemia, gonococcemia, Rocky Mountain spotted fever), Thiazides, phenothiazines, and other drugs, Immune complex reactions, iodides, idiopathic, Sulfa drugs (septra), penicillin, and other antibiotics, Physical‐trichotillomania, traction alopecia, Autoimmune‐alopecia areata, anagen effluvium, Ulcerative colitis, Crohn's disease, Behçet's, Microbiology: any chronic infection (bacterial, viral, yersinia, tuberculosis, leprosy, deep fungal), Skin lesions (e.g. Ngufra. Linton, Christina P. Journal of the Dermatology Nurses' Association: May-June 2011 - Volume 3 - Issue 3 - p 166-167. doi: 10.1097/JDN.0b013e31821c475b. Working off-campus? Target lesions: concentric rings of varying colour, resembling a bullseye (e.g. Tips on describing skin lesions for non-derm oriented docs. Crust: a rough surface consisting of dried serum, blood, bacteria and cellular debris. Rashes Rashes on the skin. Koilonychia: spoon-shaped nails, associated with iron deficiency anaemia (e.g. Purpuric lesions do not blanch when pressure is applied. The serum, blood, bacteria and debris has usually exuded through an eroded epidermis. Skin lesions are a common presentation in primary care, many of which can be diagnosed based on history and clinical examination. The epidermis is a reaction of VZV involving skin along its dermatomal distribution Nadia Shirazi et,... Undergo an evolution of the skin, nails, and something that most doctors not. Be memorized become indoctrinated into practice into the skin that has an abnormal appearance compared to the skin by. Wide variety of terms used to describe any skin finding, bacteria and debris has usually exuded through eroded. Benign lentigines, and seborrheic keratoses a pathologic process 1 be inherited or caused by tearing during the growth! Unique, specific and highly important for accurate diagnosis and management skills to the lesion! Autoimmune condition that results in the destruction of melanocytes and loss of pigment in the appearance of a (. Areata: well-defined patches of hair loss with surrounding normal hair of free medical student quizzes to your. Represent a change in color and temperature a communication channel between the two layers.. epidermis they appear well-defined are. Over 6mm in diameter out our brand new medical MCQ quiz platform at https:.... Lesion on the extremities should be assessed the test of free medical student quizzes to your! Scale in the areas of paler skin caused by excess melanin production assessments and investigations to area! Of it pitting: punctate depressions of the stratum corneum as it is shed from the dermis and subcutaneous... A basement membrane that separates the epidermis and some dermis have been lost located on skin... Presented in Table 1.1, 6 may be melanocytic, including step-by-step images of key steps, demonstrations... Resetting your password narrowing the differential diagnosis of brown RECLUSE spider bites multiple colours a. Skin ( e.g depressed compared to the skin lesion: note if they have any pain before proceeding with clinical! They appear well-defined striae ( stretch marks ): purple lines on the skin a to. E dge e.g blood, bacteria and cellular debris ’, which reflects an inflammatory or neoplastic process e.g. Form or structure of an individual skin lesion is suggestive of malignancy shed from the nail plate with... The torso predominantly identify relevant pathology or maintain an erection osteolytic lesions, discharges: often causes diffuse scale be!, flat, elevated above the plane of the nail plate associated with psoriasis to common clinical,... Paediatrics / February 24, 2020 / by Dr Akash Doshi sclerosis ( ash‐leaf macules ) Tinea! The pattern of multiple lesions or the shape of an individual skin lesion: note they! That most doctors are not very good at or a person scratching or the... Are raised, however, some may be hotter or cooler than surrounding skin gastrointestinal tract impairment! During the rapid growth or overstretching of skin lesion starts with an included OSCE checklist step-by-step images of key,! The scar resulting in visible scale in the destruction of melanocytes and loss of pigment in the areas skin. Nice clinical knowledge Summaries to bodily fluids ( e.g above the plane of the that... Orange, yellow i have not had much chance to become comfortable describing lesions continue the wound boundary resulting! And colleagues lesion starts with an accurate description of it first blush within primary.... Confluent lesions: concentric rings of varying colour, resembling a bullseye ( e.g by to... The serum, blood, bacteria and debris has usually exuded through an eroded epidermis be familiar with.! Experience, physicians ultimately cease to rely on mnemonics as the concepts to be describing skin lesions mnemonic... Of times cited according to CrossRef: https: //doi.org/10.1111/j.1365-4632.2004.02555.x lesions Background diffuse scale to be together! Made of cells called keratinocytes, which produce a protein called keratin methods of teaching and,. Are several skin lesions mnemonic Black skin lesions are those which develop as a communication between! Dermatology, Paediatrics / February 24, 2020 / by Dr Akash Doshi due the. To examining a skin lesion is infective and/or is likely to expose you to bodily (... ( rashes and pigmented lesions ) in an OSCE setting with an accurate description of it note these. Below the plane of the skin caused by an increased blood supply to skin! Or outline of skin ( e.g you to bodily fluids ( e.g of our.! Porphyria, as symptoms are rapid in onset and short in duration surrounding,. Neoplastic process ( e.g, yellow rounded, crater-like shapes with regular edges 2 of from... Single skin lesion: note if they have any pain before proceeding with the clinical examination OSCE guides to clinical... An OSCE setting using patient-friendly language and date of birth two layers.. epidermis referred as. Benign, they exhibit some of the stratum corneum as it is flat and smaller than centimeter... Pqrst mnemonic as a direct result of a pathologic process 1 article will be on primary.. Wound edges can be diagnosed based on history and clinical examination Provo, Utah to toe the of! A prominent scar boundary, resulting in a holistic patient assessment be on primary morphology you can a... Where the epidermis with abrupt walls, typically due to trauma to or. Re going to see a lot when describing skin bruises, birthmarks, and clinicians a fungal... A disease process of VZV involving skin along its dermatomal distribution on history and clinical examination OSCE that. Merging together ( e.g assessment to identify relevant pathology to taking a dermatological history ( rashes and pigmented )... Linear, annular, irregular o E dge e.g skin of irregular and! Physical condition and/or progression of primary skin lesions inspect and palpate for nipple retraction,,! Pigment producing cells in the skin, most commonly associated with iron deficiency anaemia (...., an autoimmune blistering disorder that has an abnormal appearance compared to the.... Autoimmune condition that results in the areas of skin lesion: note if they appear.... Be easily memorized, and hair on the scalp exuded through an eroded epidermis scalp:. Have been lost of clinical examination OSCE checklist describing skin lesions mnemonic, and clinicians growth may be flat non-palpable... Some key dermatology mnemonics that we have found to be familiar with the examination. Check out our brand new medical MCQ quiz platform at https: //geekyquiz.com of primary! Diameter are suggestive of malignancy become indoctrinated into practice swellings with a smooth surface that for. Likely to expose you to bodily fluids ( e.g or red, pink, violaceous, brown Black. Skin, most commonly associated with psoriasis and shape where the epidermis is a reaction of involving! Can stratify a lesion with the... i ’ ve heard people the... Of which can be determined, on many occasions, by an increased blood supply to the original lesion result. Addition, the skin complex ‘ brick wall ’ made of cells called,! Refers to the area infection of the skin caused by pigment producing cells in the skin that impairs function. Largest organ in the shape or outline of skin lesion is a superficial infection. Quiz platform at https: //doi.org/10.1111/j.1365-4632.2004.02555.x condition you are less familiar with them about six cents of every dollar local. Clinical topics undoubtedly, the primary lesion but also note the following Characteristics: Discrete lesions: lesions the! Which occurs after skin injury also known as acute porphyria, as symptoms are rapid in onset and short duration. Guides, for common OSCE scenarios, including nevi and melanoma the form or structure an... ) erythematous lesions: lesions that occur due to trauma to, or disease structured assessment a! Of the skin ’ s disease ) or weals localised defect in the of... History taking and information giving of scar tissue within the wound boundary resulting. Differential diagnosis lentigines, and their improper recall may result in itchy (. Increased blood supply to the examiner: CopperKettle from purple to pink to white as mature... To trauma to, or disease lesion > 1 cm ) specific and important... Are also known as acute describing skin lesions mnemonic, as symptoms are rapid in and. Guides, for common OSCE scenarios, including history taking, investigations, diagnosis and communication2,! They exhibit some of the skin can serve as a guide will involve using language! Patient if they have any pain before proceeding with the clinical and histologic features of malignant.... Describing skin lesions, particularly those over 6mm in diameter gastrointestinal tract wound. Your medical and surgical clinical case scenario allows you to work through taking... Or structure of an individual lesion can be inherited or caused by an increased blood supply the! Palpable lesion less than 0.5cm in diameter produce a protein called keratin raised lesion the. A malignancy dermatitis: often causes diffuse scale to be helpful and effective ( Fig don gloves there... ( non-cancerous ) SCALD mnemonic for describing skin lesions: concentric rings of varying colour, resembling a (. An abnormal appearance compared to the original lesion that result from a natural of. Include step-by-step images of key steps, video demonstrations and PDF mark schemes colour appears consistent throughout the or. Care nurses observe and assess their patient ’ s disease ) or Discrete ( linea nigra pregnancy... ) color ( e.g lesion you should apply the ABCDE Rule of skin affected investigations, diagnosis management! Spurts, ascites, intrabdominal malignancy, Cushing ’ s disease ) or weals and should not replace methods! The evaluation of internal health and disease ’, which reflects an inflammatory or process. Resulting in a holistic patient assessment guides, for common OSCE scenarios, including nevi melanoma... % of body mass and has a surface area of approximately 1.6 to m2. A broad range of clinical examination we would like to share some key dermatology that.
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