Distribution of lesions along distal aspects of the head (ears, nose) and extremities is described as
Acral
Distribution of lesions along area of skin supplied by a particular nerve root, does not cross midline of body
Dermatomal
Lesions distributed within skin folds and creases
Intertriginous
Photodistributed lesions might be found -
Sun-exposed areas
forehead
nose
ears
cheeks
upper lip
neck
forearms
dorsum of hands
lesions arranged in a ring shape
Annular
lesions arranged in an arc shape
Arcuate
Lesions arranged in a netlike shape
Reticular
Clustered lesions
Grouped
Lesions arranged in coalescing circles / rings
Polycyclic
Snake-like arrangement of lesions
Serpiginous
Target / bulls’ eye lesion
Targetoid
Stirred appearance of lesion/s
Whorled
Most common form of systemic vasculitis in children
Henoch-Schonlein Purpura
palpable purpura, arthritis, abdominal pain, and kidney disease.
Seasonal pattern with a peak in incidence during the winter
supportive Tx +/- prednisone
Painful subcutaneous hypermigemented nodules which can ulcerate along medium sized vessels
Fever, decreased sensation and reflexes
May also present with livedo reticularis
May affect any organ, most often skin, peripheral nerves, kidneys, joints, GI tract
Polyarteritis Nodosa
Most common skin disorder in developed countries affecting up to 20% of children and 1-3% of adults
Develops before the age of 5 years and generally clears by adolescence
Atopic dermatitis
Type IV delayed hypersensitivity response to numerous antigens
Inflammatory process involving the septa between subcutaneous fat lobules, with an absence of vasculitis and presence of radial granulomas.
Typically on shins
Begin as flat, firm, hot, red, painful lumps that are about an inch across
Within a few days they may become purplish
Over several weeks, the lumps fade to brownish, flat patch
Erythema Nodosum
3 questions to ask when evaluating a pigmented lesion
Has it remained the same for the last year or so?
Is it symmetric, distinct borders, primarily one color?
Is it similar to other moles?
if yes to all 3, likely benign
Melanomas are usually > _____ mm but can be smaller
> 6mm
Indications for biopsy
ABCDE’s
Changes
New Lesions
> 50 yrs old
“ugly duckling”
Most common form of skin cancer, >1 million cases per year in the US
Basal Cell Carcinoma
Erythematous papules or plaques with rolled boarders. Telangectasias in sun-exposed areas. Fragile, will bleed or scab easily with minimal trauma.
Basal Cell Carcinoma
Other conditions to R/O when considering basal cell carcinoma
Sebaceous hyperplasia
Fibrous papule
Tx of choice for basal cell carcinoma
Surgical removal
Curette and Desiccation
Cryosurgery
Excision with standard 3-4mm margins
Moh’s micrographic surgery
Tx for non-surgical, superficial BCC
Imiquimod
5% fluorouracil cream
Photodynamic therapy
Radiation
BCC prognosis
locally invasive, rarely metastatic. Increased risk for other non-melanoma and melanoma skin cancers
Most common type of melanoma (?)
Superficial spreading. Horizontal growth, as opposed to vertical.
- on back in men
- back and legs in women
Type of melanoma with rapid growth, more aggressive. Growth is vertical, so thicker tumors.
Nodular
“sunspot”
Lentigo maligna
Occurs on chronically sun-damaged skin, more common in elderly patients. Slow progression. Growth tumor is primarily horizontal.
Melanoma more common in people with darker skin color (African or Asian). Diagnosis is often delayed, so lesions tend to be larger. Look at the soles of your patients feet.
Acral lentiginous`
characterized by a marked increase in dermal thickness on the upper neck or posterior back. It is found mostly
in overweight, middle aged, poorly controlled type
II diabetics
Diabetic Scleroderma
Pediculosis
Head lice
oval salmon colored lesions in a Christmas tree pattern
Pityriasis Rosea
Most common infections of the hand
Paronychia
Acute: staphylococcus, streptococci, pseudomonas
Nail biting, finger sucking, aggressive manicuring, trauma, hang nail
Chronic: Yeast – candida, atypical mycobacteria, gram negative rods
Repeatedly exposed to water or irritants
precancerous skin lesion caused by chronic sun exposure. These lesions are typically pink or red in color and rough or scaly to the touch. They occur on sun-exposed areas of the skin such as the face, scalp, ears, backs of hands or forearms.
actinic keratosis
Actinic keratoses may start as small, red, flat spots but grow larger and become scaly or thick, if untreated. Sometimes they’re easier to feel than to see. There may be multiple lesions next to each other.
arise from keratotic patches and become more nodular and erythematous with growth, sometimes including keratin plugs, horns, or ulceration
squamous cell carcinoma
Squamous cell carcinomas arising from actinic keratoses are scaly, as are actinic keratoses, but tend to grow thicker, and the pink macular to papular area develops into an erythematous raised base. Sometimes the lesion develops an overlying keratin horn (Figure 7). The lesions may take the form of a patch, plaque, or nodule, sometimes with scaling or an ulcerated center. The borders often are irregular and bleed easily. Unlike basal cell carcinomas, the heaped-up edges of the lesions are fleshy rather than clear in appearance.
Hyperkeratotic, exophytic, dome-shaped papules or plaques
Most common on fingers, dorsal hands, knees or elbows
Punctate black dots representing thrombosed capillaries
May be koebnerize: spread with skin trauma
verruca vulgaris
Skin-colored or pink
Smooth surface, slightly elevated, flat topped papules
Dorsal hands, arms, and face (exposed areas)
verruca planae
Thick endophytic (depressed into skin of sole) papules
Mosaic warts: plantar warts coalescing into large plaques
Can accumulate a thick callus over and around the wart
May be painful when walking
paloplatar verruca
