Morphology and Differential

Diagnosis

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.

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.

Macule

Macule

Macule

Patch

Papule

Papules

Papules

Papules

Plaque

Plaque

Plaque

Nodule

Nodule

Nodule

Tumor

Tumor

Tumor

Pustule

Pustule

Vesicle

Vesicle

Vesicle

Bulla

Bulla

Wheals

Wheals

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

Burrow

Comedone

Telangiectasia

Cyst

Secondary Lesions

Scale
Crust
Erosions and ulcers
Excoriations
Fissures
Scars
Lichenification
Atrophy

Scales

Scales

Scales

Crust

Crust

Excoriations

Erosion

Erosion

Ulcer

Ulcer

Ulcer

Fissure

Fissure

Atrophy

Atrophy

Atrophy

Atrophy

Scar

Lichenification

Configuration

Annular
Arcuate
Geographic
Discrete
Confluent
Serpiginous

Linear
Reticulated

Annular and arcuate

Linear

Erythema Subitum

Descriptors

Punctate
Lichenoid
Umbilicated
Scarletiniform, morbiliform
Leonine

Color

Pink
Violet
Orange
Blue
Green
Yellow
Black
Brown

Color

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

Color

Distribution

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

Urticarial
Petechial
Telangiectatis
Burrow
Poikiloderma
Hyperkeratotic/scale
Atrophic

More is missed by not looking

than by not knowing
M. McKay, M.D.

Procedures
Liquid Nitrogen
Electrodessication and curettage
Biopsy
Punch
Shave
Excision

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

Dermatosis Papulosa Nigra

Most likely a subtype
of seborrheic
keratosis
Malar areas, most
commonly on AfricanAmerican women

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

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

Dermatofibroma

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 AfricanAmericans
Treatment can be difficult and
choices include intralesional
steroids, radiation, careful
excision, laser ablation

Epidermoid Cyst

Trichilemmal (Pilar) Cyst

Actinic Keratosis

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

Keratosis Pilaris

Keratosis Pilaris

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