Dermatology: Skin Lesions

DERM: Skin Lesion Presentation | S.M.CHOK (Manchester Medical School)
Melanoma

Squamous Cell Ca

Basal Cell Ca

Eczema

Psoriasis

Impetigo

Site

anywhere in body, not
only in areas exposed
to sun

sun exposed sites, head
and neck, face, lips,
ears, hands, forearms,
lower legs

sun exposed sites, face
(nodular, morphoeic),
trunk/shoulder
(superficial)

skin creases eg folds of
elbows, knees, ankles,
around neck, cheek (in
paeds)

scalp, elbow, knees,
lower back, extensors

exposed areas of face
and extremities

Size

diameter >7mm

varies from mm to cm

varies from mm to cm

varies, large area

varies, large area

increasing from tiny
pustule to < 2cm

Shape

asymmetrical

lumps

round or irregular

asymmetrical

asymmetrical

asymmetrical

Border

irregular

irregular, hard and
raised edges

irregular but well
dermacated, rolled
(nodular type)

poorly demarcated

well demarcated

well demarcated but
irregular

Colour

tan, dark brown, black,
blue, red, light grey

keratinized red patches
or plaques

pink, red, shiny/pearly,
skin colour (nodular,
morphoeic), brown/
blue-ish/ grey-ish
(pigmented)

erythematous

erythematous

honey-coloured with
surrounding
erythematous skin

Features

flat (can become
thicknened and raised),
crust over, evolving!

slow growing, tender,
scaly, crusted, horny,
central indentation

scaly (superficial),
central ulcer (nodular)

itchy, dry, crusting,
scaling, cracking,
swelling of skin

plaque, scaly, cracking,
hyperkeratotic,

plaque, crusted,
oozing/producing pus,
non-bullous

Ass. Symp

can be inflamed, itchy,
tender, bleeding,
oozing

may develop sores or
ulcers, can become
necrotic

bleeding, slow growing
over months or years

asthma, hay fever
- can be infected:
weeping, pustulation

nail changes: pitting,
ridging, onycholysis,
hyperkeratosis

enlarged lymph nodes,
surrounding oedema,
spread rapidly

Mx

excision biopsy
- Breslow thickness
(invasiveness)
- Clark level of invasion
(↑risk of metastasis)
surgically removal,
staging and F/U

curative
surgery excision and
radiotherapy

surgery (shave, cautery) emollients, topical
excision, cryo-/radio-/
steroids, topical abx
photodynamic-therapy,
imiquimod/fluorouracil
cream

emollients, topical
steroid ointments

local cleansing, wet
dressing, prevent
scratching
- PO flucloxacillin or
erythromycin

DERM: Skin Lesion Presentation | S.M.CHOK (Manchester Medical School)
Melanocytic Naevi
(moles)

Urticaria
(hives)

Campbell de Morgan
(cherry haemangioma)

Skin Tags
(acrochordons)

Seborrhoeic keratosis
(seborrhoeic warts)

Erythema Nodosum

Site

any area of skin

any area of skin

any area, usually trunk
and extremities

skin folds: axilla, neck,
groin, eyelids

trunk, also found on
sun-exposed areas

anterior lower leg

Size

varies from mm to cm

commonly 1-2cm

1-3mm

0.2-0.5cm in diameter

start small (2mm) grow
in size (up to 3cm)

2-6cm

Shape

round or oval, unusual

often round

round

round or oval

round-ish

irregular

Border

well defined

often well defined

well defined

well defined

well defined

poorly defined

Colour

brown or black

skin colour or red, with
underlying red skin

bright cherry red

skin colour

hyperpigmented, black

erythematous, turns
purple, yellow, resolve

Features

flat or protruding

raised patches, weal

macule, can become
papule over time
non-blanching

pedunculated, hang
from skin

from macule to scaly
plaque, warty surface,
uneven, multiple
plugged follicles

nodule, tense, hard,
tender, fluctuant, do
not suppurate/ulcerate

angioedema, swollen
tongue/lips

asymptomatic

associated with obesity
and T2DM

asymptomatic, but can
be inflamed, itchy

fever, arthralgia,
aching, am stiffness

congenital
- cafe au lait patches
- mongolian spots
acquired
- sun exposure

tiny amount of fluid
leaks from blood
vessels under the skin
surface
- can be caused by
autoimmune, physical
(emotions, exercise,
hear, cold, sunlight),
allergens, H.pylori
- rash clear completely
after few hours

-middle-older age
-formed by dilated and
proliferated capilarries/
post-capillary venules
-caused by pregnancy,
prolactinoma, chemical

rubbing of skin folds or
clothing over skin

autosomal dominant?
associated with HPV?

indicative of underlying
infection:
streptococcal infection
is most common
consider sarcoid, TB, GI
infections, IBD, fungal
infection, lymphoma,
pregnancy, rarely EBV,
Hep B/C, HIV, leprosy
(Hansen's disease),
sulfonamides

excision biopsy if flat,
shave biopsy if
protruding

antihistamine

reassurance or removal

cryotherapy, excision,
electrosurgery
(diathermy), ligation

Ass. Symp
Pathology

Mx

incidence↑with age
onset is common in
middle-aged

reassurance, removal
(cryo, cautery, sahve
excision)

self-limiting.
RICE, NSAIDS, rarely PO
potassium iodide