Home Page Science Medicine Dermatology Dermatology Pathology Slides from Lecture - Flashcards

Dermatology Pathology Slides from Lecture – Flashcards

Misty Porter

7 July 2022

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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B. Papule palpable lesion, <10 mm

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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C. Patch

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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D. Plaque

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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E. Ulcer

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axilla distribution, *burrows*

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Scabies

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*burrows*

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Scabies

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*burrows*; finger web involvement

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Scabies

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RIGHT mite itself MIDDLE poop LEFT cyst

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Scabies

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Nodular Scabies

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hundred to thousands of mites

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Nodular Scabies

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pustules papulovesicles

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Fire Ant Sting

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nits

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Head lice

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Pubic Louse

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Body/Head Louse

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Tick

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Flea

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leg involvement not displaying "breakfast, lunch, and dinner" pattern

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Flea Bites

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necrotic ulceration

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Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

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necrotic ulceration

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Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

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purple, polygonal, pruritic papules and plaques commonly seen on the wrists, genitalia, and buccal mucosa

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*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

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purple, polygonal, pruritic papules and plaques *Wickham's striae* (reticulated scaling) on the *buccal mucosa* also seen on the wrists and genitalia

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*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

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"dew drops" without inflammation

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Miliaria Crystalina (Caused by occlusion of eccrine sweat ducts and seen in "hot, humid" weather. Note that miliaria *rubra [monomorphic red papules]* and *profunda [with pustules]* are progressively deeper with more inflammation.)

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keratotic firm flesh-colored to red follicularly based papules seen on lateral arms, thighs, +/- cheeks

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Keratosis Pilaris

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flat-topped, asymptomatic, shiny papules seen on arms, dorsal hands, genitalia, and trunk

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Lichen Nitidus (Histology demonstrates a characteristic *ball and claw* pattern.)

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What other body parts does this "like?" A. Eye B. Feet C. Finger D. Mouth E. Scalp

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D. Mouth *Lichen planus "likes" the buccal mucosa, specifically.*

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Name the acne.

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Open comedonal (non-inflammatory) (Acne is caused by the gram positive anaerobe **Proprionibacterium acnes**.)

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Name the acne. ("Are you impressed by it?")

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Severe Nodulocystic Acne

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central facial erythema

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Acne Rosacea (Findings include facial erythema, telangiectasias, papules, and pustules. *Does not present with comedomes.* Rosacea is exacerbated by sun exposure, ethanol, and "flushing" agents.)

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usually in males with long history of sun exposure and ethanol consumption

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Rhinophyma (This is a complication of rosacea. Ocular symptoms include blepharitis, conjunctivitis, keratitis.)

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pustules on acne patient

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Gram Negative Folliculitis (Treat with ampicillin or augmentin.)

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*honey crusts* can have vesicles or bullae

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Impetigo (Caused by S. aureus or Streptococcus pyogenes.)

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beefy red eroded plaque, intertriginous areas *satellite pustules and papules*

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Satellite Candida (Associated with obesity and DM.)

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beefy red plaque, intertriginous areas *satellite pustules and papules*

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Satellite Candida (Associated with obesity and DM.)

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*lake of pus* with skin sloughing

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Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

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Type of acne? A. Comedonal B. Inflammatory C. Mixed D. Nodulocystic E. Rosacea

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A. Comedonal

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white, well demarcated plaque of induration with rim of hyperpigmentation perhaps some violaceous change

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Morphea (Biopsy shows markedly thickened collagen bundles, with entrapment or compression of sweat glands, adnexal structures, and blood vessels. *Labs results are negative for ANA, anti-centromere, and Scl-70.*)

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*coup de sabre*

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shiny, swollen fingers difficulty opening mouth (beaked facies)

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Progressive Systemic Sclerosis (*Positive for ANA, Scl-70. Treat with physical therapy.* Complications include severe HTN, conduction defects, pericarditis, CHF, renal failure, pulmonary fibrosis; esophageal dysmotility and strictures.)

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superficial dilated blood vessels

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CREST Syndrome: Telangiectasias (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

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sausage digits, swollen, shiny

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CREST Syndrome: Raynaud's (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

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porcelain white; sharply demarcated with purpura; *cigarette paper* skin usually seen in genital area, but may be generalized

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Lichen Sclerosus (et atrophicus) (Commonly misdiagnosed as child abuse. Treat with high potency topical steroids with or without minocyclin/doxycycline.)

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annular papules/plaques with central clearing seen on the dorsal hands and feet

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Granuloma Annulare (Commonly diagnosed as *ringworm, which displays annular papules/plaques with scaling.*)

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red-brown to yellow plaques with prominent telangiectasias commonly seen on the shins

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Necrobiosis Lipoidica (Called "diabeticorum," as 2/3 of patients also have abnormal glucose metabolism.)

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What is the diagnosis? A. Granuloma annulare B. Morphea C. Necrobiosis lipoidica D. Lichen sclerosus E. Systemic sclerosis

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B. Morphea ("coup de sabre*)

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pinpoint to 3mm in size

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Petechiae (Most prominent in legs; if patient is bedridden, in back and sacrum.)

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ecchymoses; skin atrophy and bleeding usually seen on dorsolateral arms and dorsal hands

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Actinic ("Solar") Purpura (Chronic sun induces blood vessel fragility; loss of "shock absorbers" of the dermis. Skin atrophy and solar elastosis is usually severe.)

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eyelid purpura

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Systemic Amyloidosis (Also shows pinch purpura and macroglossia.)

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petechiae, purpuric stellate (irregular) ecchymosis; central necrosis most characteristic

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DIC (Uncontrolled clotting causes diffuse thrombus formation, which leads to consumption of platelets and thrombocytopenia. Other findings include prolonged prothrombin time, hypofibrinogenemia, and fibrinogen degradation products.)

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palpable purpura of the legs

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Leukocytoclastic Cutaneous Vasculitis (Check for fever and arthritis in order to rule out sepsis. Causes include SLE and RA. Order ANA, viral hepatitis panel [especially for Hepatitis C] and rheumatoid factor to determine cause.)

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necrotic, hemorrhagic pustule on extremity may also present with swollen knee

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Gonococcemia caused by N. gonorrhoeae (Culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.)

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fairly well demarcated, hypopigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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fairly well demarcated, hyperpigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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fairly well demarcated, erythematous atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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*chopped spaghetti and meatballs* KOH stain

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Tinea (Pityriasis) Versicolor (Hyphae and spores can be seen.)

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periorificial, sharply marginated white (depigmented) non-scaly patches

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Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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periorificial, sharply marginated white (depigmented) non-scaly patches

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Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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process from hair follicle outward

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Repigmentation in Vitiligo (Vitiligo is associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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hypopigmented poorly demarcated atrophic plaques with fine white scale. usually affects the cheeks; also commonly involves upper outer arms

1 year.)" alt="Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)">

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Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)

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rim of hyperpigmentation at edge scarring in center

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Postinflammatory Hypopigmentation (Can be caused by contact dermatitis, autoimmune effects, local trauma; Xrays and frostbite; phenols and sulfhydryl compounds, discoid lupus erythematosus, atopic dermatitis, psoriasis.)

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subtle, somewhat well-demarcated scaly white patches/macules

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"ash-leaf" macule/patch

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Tuberous Sclerosis (Cutaneous findings include *ash leaf macules/patches*: 80-90%, *adenoma sebacum*/facial angiofibromas): 80-90%; periungual fibromas/*Koenen's tumors*: 50% *shagreen patches*: 21-80%; flesh to yellowish-orange plaques (*orange peel/pigskin*) usually in the lumbosacral area. Other findings include calcified brain "tubers," mental retardation, seizure disorders, brain tumors, renal cysts, cardiac rhabdomyomas.) )

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4+ ash-leaf patches

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Shagreen patch "ash-leaf" patch

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adenoma sebaceum angiofibromas dental enamel pits

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Koenen's tumors

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What is the best diagnosis? A. ITP B. Leukocytoclastic vasculitis C. Neisseria infection D. Solar purpura E. TTP

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C. Neisseria infection Gonococcemia is the diagnosis; culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.

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macules, "sprinkled confetti" seen on shins of females

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Idiopathic Guttate Hypomelanosis (No good therapy.)

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hypopigmented, hypestetic macule/patch/plaque

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Leprosy (Tissue biopsy for Fite stain. Caused by Mycobacterium leprae and spread by armadillos.)

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hypopigmented areas, bathing trunk distribution

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Hypopigmented Mycosis Fungoides (Cutaneous T-Cell Lymphoma.)

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Which of the following may be found in this patient? A. Cafe au lait macules B. Coup de sabre C. Neurofibromas D. Shagreen patch

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D. Shagreen patch Cutaneous findings in Tuberous Sclerosis include ash leaf macules/patches: 80-90%, adenoma sebacum/facial angiofibromas): 80-90%; periungual fibromas/Koenen's tumors: 50% shagreen patches: 21-80%; flesh to yellowish-orange plaques (orange peel/pigskin) usually in the lumbosacral area.

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significant thinning of the parietal region no inflammation or scarring

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Telogen Effluvium (Pull test: many telogen hairs (small bulb at end of hair), club-shaped hairs. Order CBC, ANA, RPR, thyroid to rule out anemia, hypothyroidism, nutritional, toxic drugs, lupus, syphilis.)

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thinning of the vertex scalp

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no scarring or inflammation

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Androgenic Alopecia (Caused by a testosterone-induced reversion of mature hair to vellus hairs in a specific pattern; physical exam shows nonscarring, frontal, vertex affected terminal hairs replaced by vellus, smooth shiny scalp; will see diffuse thinning of vertex in women.)

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no scarring or inflammation

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vertex loss

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irregularly-shaped with variable hair length no scaling or erythema

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Trichotillomania (Caused by self-induced traumatic hair loss by plucking, twisting or rubbing; physical exam shows empty hair follicles in *strange geometric patterns*, traumatized follicles, perifollicular hemorrhage, pigmentary casts, increased number of catagen hairs.)

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diffuse thinning "difficult to tell here"

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bizarre geometric shape

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oval/round patch, exclamation point hairs

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Alopecia Areata (Caused by autoimmune hair loss; physical exam shows *round or oval patches, exclamation point hairs*, no inflammation or scarring and skin biopsy shows *"Swarm of Bees"*- lymphocytes surrounding base of hair follicles.)

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sharply demarcated, oval and smooth patch

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Alopecia Areata, Ophiasis type (most common) (Caused by autoimmune hair loss; physical exam shows *round or oval patches, exclamation point hairs*, no inflammation or scarring and skin biopsy shows *"Swarm of Bees"*- lymphocytes surrounding base of hair follicles.)

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totalis

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Nonspecific nail pitting, here associated with Alopecia Areata

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erythema scaling some scarring, possibly

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Lupus Erythematosus (Causes chronic/discoid patchy scarring or non-scarring alopecia; broken hairs at frontal hairline, carpet tack scale, dyspigmentation, inflammation. Biopsy shows interface dermatitis- lymphocytic infiltrate and DE junction, liquifactive degeneration of basal cells, follicular plugging.)

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lots of erythema scaling

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young children

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Tinea Capitis (Demonstrates scarring alopecia [*if you see scarring on the scalp of a child, think tinea*]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; *topicals do not work.*)

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exclamation point young child

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Diagnosis in this 8 year old? A. Exzema B. Discoid Lupus erythematous C. Psoriasis D. Seborrheic Dermatitis E. Tinea capitis

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E. Tinea capitis (Demonstrates scarring alopecia [*if you see scarring on the scalp of a child, think tinea*]; useful labs include Wood's light, KOH exam, culture; griseofulvin is the gold standard of treatment; *topicals do not work.*)

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"crumbly nails" debris, yellow change DIFFERENTIAL psoriasis, trauma, lichen planus

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Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

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hallux involvement

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Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

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onycholysis oil drop

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Psoriasis (Caused by increased rate of proliferation of keratinocytes; physical exam shows *nail pitting*, dystrophy, onycholysis, *"oil drop sign"* [yellow color under nail], fingernails affected more than toenails.)

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pitting

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nail and skin involvement pustules, "lakes of pus"

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Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

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red, swollen

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Acute Paronychia (ACUTE S. aureus infection leading to inflammation and infection of proximal and lateral nail folds; red, swollen, painful; CHRONIC Candida infection leading to inflammation and infection of proximal and lateral nail folds; loss of cuticle, creases in nail plate, scaling)

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swollen

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180 degrees)" alt="Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)">

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Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)

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spoon-shaped

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Koilonychia (Caused by iron deficiency anemia, Plummer-Vinson syndrome, Hemachromatosis, CAD, syphilis, polycythemia, acanthosis nigricans, familial forms; physical exam shows spoon nails, thin and concave)

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transverse furrows affecting all nails

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Beau's Lines (Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails *grow out at a rate of 1mm/month.*)

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What is the diagnosis? A. Beau's lines B. Clubbing C. Fungus D. Koilonychia E. Paronychia F. Psoriasis

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A. Beau's Lines (Temporary arrest of growth of nail plate leading to ransverse furrows that grow out; Triggered by traumatic/stressful events: childbirth, febrile illness, drug reaction. Note that the nails *grow out at a rate of 1mm/month.*)

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medial aspect of lower leg full thickness epidermal loss with petechiae (pinpoint - 3 mm)

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Stasis (Venous Insufficiency) Ulcers (Common in CHF and incompetent leg vein vales; physical exam shows significant, bilateral swelling of medial lower legs, brownish dyspigmentation and petechiae, commonly *Most common etiology of leg ulcers,* check DP/PT pulses to rule out associated arterial disease.)

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sharply demarcated, "punched out" ulcer

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Arterial Ulcers (History commonly shows intermittent claudication, rest pain; physical exam demonstrates punched out ulcers on the lateral aspects of the legs (classically); DP/PT pulses absent, cool extremities, local hair loss.)

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cribriform scarring

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Pyoderma Grangrenosum (Physical exam shows distinctive ulceration: acute onset of a painful ulcer with an undermined border [Dr. Stetson likes to say "you could stick a probe into it"], which heals with *cribriform scarring*; associated with ulcerative colitis, rheumatoid arthritis, and acute myeloblastic leukemia; *biopsy reveals neutrophils throughout the dermis, but cultures are negative.*)

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Chancre in Primary Syphilis (Note that the *chancre caused by Treponema pallidum is painless*, whereas the *chancroid caused by Haemophilus ducreyi is painful*.)

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dark field microscopy

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Spirochetes (You can test for the syphilitic Treponema pallidum by dark field microscopy.)

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*"nickles and dimes" on palm*

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Secondary Syphilis HIGHLY STRESSED)

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"moth-eaten" alopecia

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Secondary Syphilis

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"punched out, painful" ulcers

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Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

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painful, ragged ulcer "undetermined" NOTE difficult to culture

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Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

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"school of fish" gram negative coccobacilli

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Haemophilis ducreyi (Causative agent of chancroid.)

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grouped ulcerations on erythematous base

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HSV

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grouped vesicles on erythematous base

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HSV

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Tzanck smear showing multinucleated keratinocytes, ballooning degeneration steel-gray nuclei chromatin margination

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HSV

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*angulated linear heme-crusted ulcer*

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Factitial Ulcer (Causes include a variety of insults: deep excoriations, injections of foreign material, heat/cold. Note that the patient will often deny causing the ulceration and the history will be unreliable. These ulcers appear as bizarre, geometric shaped angulated ulcers. Must be suspected clinically; especially if location is unusual for ulcerations, and there are no other explanation for the ulcer.)

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What is the best diagnosis? A. Arterial ulcer B. Factitial ulcer C. Pyoderma gangrenosum D. Stasis ulcer E. Syphilis

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C. Pyoderma gangrenosum Note underlying edge, where "one could stick a probe."

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cheek, arms

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Eczema, Atopic Dermatitis (Most common form is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)

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plaque, erythematous papules seborrheic appearance

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Eczema, Atopic Dermatitis (Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *childhood form favors flexors; often lichenified*; 40% have persistent disease as adults)

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possible lichenification in the cubital fossa

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Eczema (Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *childhood form favors flexors; often lichenified*; 40% have persistent disease as adults)

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hyperlinear palms

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Eczema (Associated with keratosis pilaris, xerosis, icthyosis vulgaris, Dennie-morgan lines, *hyperlinear palms*, pityriasis alba; can become erythrodermic. Often impetiginized [S. aureus, honey crusted] or considered *eczema herpeticum [painful super-infection by HSV]*).

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thickening NOTE the papulovesicles on the lateral finger

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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"plate-like or fish-like" changes dry river bed

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Asteatotic Eczema (Appearance is termed "eczema craquele" and "dried river bed;" favors shins, flanks, post axillary line. Associated with aging, xerosis, low humidity, frequent bathing)

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*coin-shaped*, scaly

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Nummular Dermatitis (Appears as pruritic coin-shaped eczematous lesions with a chronic, recurrent course. Associated with contact sensitization and stasis, but not atopy. More common in older patients.)

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eye involvement linear pattern

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Phyto Contact Dermatitis (Poison Ivy here) (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

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eczematous changes with vesicles

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Acute Contact Dermatitis (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

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Contact Dermatitis, caused by leather (Usually eczematous in appearance; caused by irritants in 80% of cases and by allergies in 20% of cases [this includes application of *Neosporin/Polysporin/Triple antibiotics or topical benadryl*])

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scalp involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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intertrigious area

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Seborrheic Dermatitis, here as cradle cap in infant (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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eyebrow scaling

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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scalp and forehead involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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brown, angular, ring shaped could be fungal

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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impressive scaling and redness over the face guttate (drop-like)

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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varicosities, venous ulceration pigmentary changes

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Stasis Dermatitis (Appears as eczematous dermatitis due to venous insufficiency and dependent edema; often associated with allergic contact dermatitis. Stasis dermatitis is often seen in combination with venous hypertension, varicosities, edema, venous ulceration, hemosiderin deposits, and lipodermatosclerosis, and confers a risk for stasis ulcer and contact sensitization/ dermatitis)

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petechiae, ulceration, hyperpigmentation

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pigmentary changes only, longstanding

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Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

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spikiness; not all at same level vertical streaking of collagen *irregular epithelial hyperplasia* NOTE compare to psoriasis histology

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Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

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irregular presentation linear heme crusts post inflammatory changes

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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old scarring from past flares angulated upper back only

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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linear scratches DIFFERENTIAL contact dermatitis

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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bizarre ulceration pattern

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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sharply demarcated, erythematous papules, plaques, some annular (central clearing) not very much scaling truncal predominance

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Pityraisis Rosea (Appears as *classically well circumscribed papules and plaques* in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)

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sharply demarcated annular and erythematous papules and plaques truncal distribution

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Pityriasis Rosea (Appears as *classically well circumscribed papules and plaques* in a "Christmas" or "fir" tree appearance on back, upside down on chest; primarily involves trunk. The primary plaque is referred to as a herald patch.)

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papulosquamous eruption at scalp thick scaling

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Psoriasis (Appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

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papulosquamous eruption sharply demarcated scaly

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very erythematous swollen joints with potential arthritic changes

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*nail pitting* plaque on right

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onycholysis *oil drop*

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club shaped equal level NOTE compare to histology of lichen simplex chronicus

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Psoriasis (Dermatologic appearance is a classic papulosquamous eruption favoring elbows, knees, scalp, and sacral area, *usually sparing the face*. Nail findings [onycholysis, pits, oil drop (most specific] are highly correlated with arthritis.)

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*Monroe's microabscess* NOTE compare to histology of lichen simplex chronicus

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plaques, slightly scaly buttocks and lower trunk most affected

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Mycosis Fungoides, a cutaneous T cell lymphoma (Erythrodermic patch progresses to intensely pruritic, well-developed plaques in a *bathing trunk distribution* [clinically diagnostic]. These then progress to low grade, insidious tumors. Less developed lesions are typically not pruritic. Median duration from onset to definitive diagnosis is 4-6 years. Dermatopathic lymphadenopathy usually present.)

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orange/salmon color some scaling

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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annulare with scaling

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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segmented; hyphae in fungus

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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What is the most likely diagnosis? A. Allergic contact dermatitis B. Candidiasis C. Eczema D. Psoriasis E. Tinea

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/c-eczemanote-that-this-is-on-the-cheek-in-a-child-approximately.jpg" title="C. Eczema Note that this is on the cheek in a child approximately <2 months. Psoriasis does not "like" the face. (Most common form of eczema is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)" alt="C. Eczema Note that this is on the cheek in a child approximately

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C. Eczema Note that this is on the cheek in a child approximately <2 months. Psoriasis does not "like" the face. (Most common form of eczema is atopic dermatitis; appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *infantile form favors face*, scalp and extensors; 80% develop allergic rhinitis)

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round, "punched out" ulcers yellow/white necrotic base with surrounding erythema

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Aphthous Stomatitis (Affects 20-60% of the population and manifests as recurrent, idiopathic oral ulcers commonly called "canker sores" with a whitish, yellow necrotic surface/base and surrounding erythema; variants include herpetiform and major aphthae [1-3 cm; may be an initial manifestation of Behcet's, but this is rare in Lubbock].)

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uncommon oral ulcer

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Histoplasmosis

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uncommon oral ulcer

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Pemphigus Vulgaris (90% will develop oral ulcers, and 50% present with oral ulcers, may involve buccal mucosa or tongue.)

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uncommon ulcerative scarring of mucosa

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Mucosal/Cicatricial Pemphigoid

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blister on erythematous base

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Herpes Labialis

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blisters, erythema around it on hand

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Hand, Foot, Mouth Disease (Diagnosis especially likely if dermatologic findings are in a child.)

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Squamous Cell Carcinoma of the Lip

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Squamous Cell Carcinoma of the Tongue

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plaque

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Leukoplakia (Appearance is a "white-plaque" that does not scrape off, commonly seen in the middle aged and elderly with history of gradual onset, smoking, snuff, dentures. Biopsy shows hyperkeratosis, acanthosis, dysplasia and atypia, lymphocytic infiltrate, carcinoma in-situ.)

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plaque

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histologically appears like psoriasis

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Geographic tongue (Occurs after eating hot foods or drinking hot beverages; benign finding that will heal.)

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What is the best diagnosis? A. Candidiasis B. Cicatricial pemphigoid C. Herpes virus infection D. Pemphigus vulgaris E. Syphilis

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C. Herpes virus infection

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Is this lesion malignant? A. True B. False

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A. True Note the pearly color and presence of telangiectasias. This is a basal cell carcinoma.

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flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

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Verruca Vulgaris, the Common Wart (Caused by multiple types of human papilloma virus infecting epidermal cells. Appears as flesh-colored firm papule or nodule with hyperkeratotic (corrugated) surface with black dots, interrupting normal skin lines. Commonly found on hands, fingers. Treat with *non-specific destruction*.)

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flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

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Slightly raised, flat surfaced papule

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Flat Warts

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often covered by callus can be painful

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Plantar Warts

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soft, moist papule cauliflower-like

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Condyloma Acuminatum, the Venereal Wart (Appears as a soft, moist papule or plaque, can be sessile or pedunculated and is often cauliflower-like.)

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yellow-brown, well circumscribed, scaly papules not interrupting skin lines usually on feet and toes

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Corn (Clavus or Heloma) (Localized thickening of epidermis caused by pressure or friction, appears as white-gray or yellow-brown, well circumscribed, scaly papules or nodules that *do not interrupt skin lines*; most commonly involving toes. )

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tan to dark brown; round and waxy *"stuck on"*, like you could peel it off

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Seborrheic Keratosis (Arises as benign neoplasm of epidermal cells; appearance varies in size and color: flesh, tan, brown, occasionally black; oval to round, waxy, well-demarcated, *"stuck on"* appearance; may have *verrucous* or crumbly surface, occasionally with keratin-filled pits. Spares palms and soles.)

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tan to dark brown; round and waxy-appearing *"stuck on"*, like you could peel it off

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soft, *pedunculated* papule

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Skin Tag (An extremely common benign fleshy tumor; appears as a tan- to flesh-colored, soft *pedunculated* papule with smooth, folded surface. Commonly found on the eyelids, neck, and skin folds (inframammary, axilla, inguinal). No therapy is necessary.)

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flesh-colored papules with smooth, folded surface in the axilla

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hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

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Molluscum Contagiosum (Caused by *poxvirus infection* of epidermal cells, common in childhood; also venereal transmission as an adult; *suspect HIV if 100s of persistent lesions*; will commonly see pontaneous *remission* over several months. Appears as 2-5mm hard, smooth, dome-shaped flesh colored or translucent papules demonstrating *central umbilication with 'cheesy' core content*.)

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hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

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rough, yellowish adherent scale

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/actinic-keratoses-sun-spotsprecancerous-epidermal-neoplasm-caused-by-exposure-to-uv-light-appears-as-1-10-mm-wide-reddish-ill-defined-indistinct-borders-with-rough-yellowish-adherent-scale-o.jpg" title="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)" alt="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~

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Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)

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rough, yellowish adherent scale

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/actinic-keratoses-sun-spotsprecancerous-epidermal-neoplasm-caused-by-exposure-to-uv-light-appears-as-1-10-mm-wide-reddish-ill-defined-indistinct-borders-with-rough-yellowish-adherent-scale-o.jpg" title="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)..." alt="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~

answer

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scaling, indurated nodule

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Squamous Cell Carcinoma (Malignancy of *keratinocytes caused by UV light with potential to metastasize* [2% overall], appearing as a scaling, indurated plaque or nodule that sometimes bleeds or ulcerates. Persistent ulceration or bleeding warrants a biopsy. *Treat by surgical excision*)

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scaling plaque

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red, scaly, crusted and well-defined plaque

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Bowen's Disease (Squamous Cell Carcinoma in Situ)

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rapidly growing, crater-like nodule

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Keratoacanthoma (May involute, but difficult to differentiate from SCC, so treat regardless.)

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pearly, semitranslucent nodules central depression

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Basal Cell Carcinoma (Malignancy of the *epidermal basal cell* that rarely metastasizes, but can be *locally destructive*; caused most commonly by *UV radiation*, nodular subtype most common. Appears as a *pearly*, semitranslucent papule or nodule, often with central depression and *telangiectasias*. Borders are rolled and waxy or cratered. *Treat with surgery.*(

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ulceration and crusting pearly appearance with telangiectasias

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Basal Cell Carcinoma with Rodent Ulcer (Malignancy of the *epidermal basal cell* that rarely metastasizes, but can be *locally destructive*; caused most commonly by *UV radiation*. Appears as a *pearly*, semitranslucent papule or nodule, often with central depression and *telangiectasias*. Borders are rolled and waxy or cratered. *Treat with surgery.*)

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pearly with rolled margin shiny blue-black color, speckled

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Pigmented Basal Cell Carcinoma

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pearly with telangiectasias blue-black color, speckled

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Pigmented Basal Cell Carcinoma

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red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

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Superficial Basal Cell Carcinoma

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red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

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Superficial Basal Cell Carcinoma

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atrophic white plaque that looks like scar

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Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

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atrophic white plaque that looks like scar

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Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

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flesh-colored solitary nodule with central pore

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Epidermal Inclusion Cyst / Epidermoid Cyst (Derived from the upper portion of the hair follicle lining and commonly located in the mid and lower dermis. *Discharges cheesy, foul-smelling macerated keratin*. Appears as a flesh-colored, firm, but often malleable, solitary nodule with central punctum or pore. *Multiple epidermal inclusion cysts are a feature of Gardner's syndrome.*)

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flesh-colored solitary nodule with central pore

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bright red lesion

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Hemangioma, Superficial (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

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bluish lesion

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Hemangioma, Subcutaneous (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

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bright red, dome-shaped lesion

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Hemangioma, Mixed (Benign proliferation of blood vessels in dermis and subcutis, most commonly arising in infancy and regressing spontaneously after first year of life; color depends on size and depth of vessels.)

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Pinching shows central dimpling Light tan to dark brown

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Dermatofibroma (Dermal fibrotic papule or small nodule of unknown origin, possibly trauma; appears as a slightly elevated area ~5mm, often with overlying hyperpigmentation and epidermal thickening. When palpated, these are firm and indurated; demonstrate *"dimple sign."*)

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dark brown, overlying hyperpigmentation and thickening

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dark brown elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

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Keloids (Exuberant scar tissue due to *excessive proliferation of collagen*, most common in young black people. Appear as *overgrown scars*; pink to dark brown, elevated, firm, protuberant nodules/plaque; *more extensive than the original wound*; irregular claw-like borders. New and active lesions *often itch*. Treat these cautiously due to their high recurrence rate.)

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pink elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

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rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

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Lipoma (Benign subcutaneous *fat* tumor, most common in midlife. Appears as freely mobile, rubbery, flesh-colored nodules, only slightly elevated above the skin's surface, but easily palpable deep in skin. Biopsy if rapidly growing; therapy is usually not required, but if desired can be excised.)

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rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

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soft, flesh-colored, protruding papule or nodule DIFFERENTIAL skin tags

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Neurofibroma (Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; appear as soft, flesh colored *protruding papule* or nodule which demonstrate characteristic *"buttonhole sign"* [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")

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large, deep, firm nodule "feels like a bag of worms"

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Plexiform Neurofibroma (Focal proliferation of neural tissue in the dermis; multiple lesions are seen in Neurofibromatosis Type 1 [von Recklinghausen's disease]; most commonly appear as soft, flesh colored *protruding papule* or nodule which demonstrate characteristic *"buttonhole sign"* [when compressed, the papule feels like it can be pushed through a defect in the skin]; less often, these can be deep, firm nodule [plexiform neurofibroma] and be tender; "feels like bag of worms.")

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yellowish plaques on eyelids

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Xanthelasma (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

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reddish-yellow papules and plaques

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Eruptive Xanthomas (*due to very high triglycerides* (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

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potato-like nodules commonly seen on elbows, buttocks

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Tuberous Xanthoma (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

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deep, flesh-colored, hard nodules located within peripheral tendons most commonly involving Achilles tendon and extensor fingers

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Tendon Xanthomas (*due to very high cholesterol) (Focal collection of *lipid-laden histiocytes* in dermis or tendons with yellow appearance due to fat composition; *usually a skin sign of hyperlipidemia* [not always in case of xanthelasma]. All xanthomas except tendon types are yellow papules, plaques, and nodules.)

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purple macules, papules, plaques, and nodules

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Kaposi's Sarcoma (Malignant *vascular tumor caused by HHV8*; appears as *purple* macules, papules, plaques and nodules. In classic Kaposi's Sarcoma (elderly men of Mediterranean descent), it appears as lower leg lesions. If AIDS-associated, the lesions may appear anywhere.)

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purple macules, papules, plaques, and nodules

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hyperpigmented macules

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Freckle/Ephelis (Sun-induced hyperpigmented macules that only occur in sun-exposed areas; very common. *Amount of melanin is increased*, but number of melanocytes stays the same.)

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hyperpigmented macules

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Lentigo (Hyperpigmented macule caused by *increased number of melanocytes* Two main types: (1) Lentigo simplex: childhood, idiopathic, few in number, (2) Actinic lentigo: adults, *sun induced*, often numerous, more common.)

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hyperpigmented macules

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light to dark brown macule

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Junctional Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

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brown, rough-surfaced papule

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Compound or Intradermal Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

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flesh-colored smooth-surfaced papule

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variegated in color; irregular, indistinct border erythematous background

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Dysplastic Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

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variegated in color; irregular, indistinct border

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elevated, dark brown papule or plaque with discrete borders

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Congenital Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

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elevated, dark brown papule or plaque with discrete borders NOTE large congenital nevi (> 20cm) have increased chance of developing into melanoma

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Cognenital Nevus (Benign common neoplasm of pigment-forming cells [*the nevus cell*], generally having uniform color, surface, and border [changing or symptomatic nevi are suspicious!]. Note that darkening, itching, and development of new nevi are common during pregnancy and adolescence. Types of nevi: (1) Junctional: nevus cells confined to base of epidermis, (2) Compound: nevus cells in epidermis and dermis, (3) Intradermal: nevus cells in dermis only. They vary greatly in appearance and may be any of the following: flat or elevated, smooth or verrucoid, polypoid or sessile, flesh colored to tan to dark brown to blue, often contains hair.)

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irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

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Superficial Spreading Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. Note that *superficial spreading melanoma is the most common type.*)

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irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

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rapidly growing, blue-black, eroded nodule occur anywhere on the body

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Nodular Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

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rapidly growing, blue-black, smooth nodule occur anywhere on the body

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multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

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Lentigo Maligna Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus.)

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multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

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irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

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Acral Lentiginous Melanoma (Malignant neoplasm of pigment-forming cells [melanocytes and nevus cells] demonstrating an increasing incidence [1 in 70 lifetime risk]. 50% of melanomas are associated with a nevus. *Note that acral lentiginous melanoma is most frequent in blacks and Asians.*)

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irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

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Main treatment is surgical excision, with increasing margins for increasing thickness.

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Survival Statistics Based on Melanoma Depth

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shiny, blue-black color, speckled rolled borders; waxy and cratered

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Pigmented Basal Cell Carcinoma

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irregular in color, surface, border

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Superficial Spreading Melanoma

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variegated in color; irregular, indistinct border

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Combined Melanocytic Nevus

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This vesicular eruption is caused by: A. HSV B. VZV C. Poison Ivy D. Streptococcus

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C. Poison Ivy Linear and geometric patterns usually have their source outside the body.

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grouped vesicles on erythematous base

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HSV (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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grouped vesicles on erythematous base fingers

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Herpetic Whitlow (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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generalized skin infection with predisposing skin disease

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Eczema Herpeticum (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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Tzanck smear multinucleated giant cells

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HSV

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grouped vesicles in plaque

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Chronic HSV

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generalized, pruritic vesicular eruption various lesions (macules, papules, vesicles) "dewdrop on a rose petal"

vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)" alt="Varicella (Caused by primary VZV infection. Crops of macules develop into papules --> vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)">

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Varicella (Caused by primary VZV infection. Crops of macules develop into papules --> vesicles --> pustules --> crust. Typically all types of lesions seen at the same time 'Dewdrop on a rose petal' is classic.)

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unilateral eruption of groups of vesicles along dermatome

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Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

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unilateral eruption of groups of vesicles along dermatome

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Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

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Superficial desquamation beginning.

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Superficial desquamation after toxic erythema.

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erythematous plaques, violaceous hue; sun exposure DIFFERENTIAL drug reaction

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sparing of the nasolabial folds; "butterfly rash"

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redness, warmth, swelling, pain intact epidermis blisters occur only rarely

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Cellulitis (displaying the four cardinal signs)

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Fungal Cellulitis (cannot determine cause by observation)

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sharply demarcated red plaque with orange peel appearance (follicles accentuated)

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associated hair follicle

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Furuncle

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no associated hair follicle fluctuates when pressed

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Abscess

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red, ill-defined nodules with bruise-like appearance on shins will be painful when touched

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Erythema Nodosa (Causes: Strep, OCPs, Pregnancy, or idiopathic)

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sharply demarcated red plaques, later dusky same lesion can reappear prefers the distal extremities, face, lips, and genitalia

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Fixed Drug Eruption (Causes: *NSAIDs, sulfonamides,* tetracyclines, carbamazepine)

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persistent flushing of the face due to high levels of 5HT

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Carcinoid Syndrome

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cutaneous metastases mimicking cellulitis painful, hot

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Carcinoma Erysipeloides

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slightly raised, some blanching at border edematous plaques

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/urticariaindividual-lesions-last.jpg" title="Urticaria (*Individual lesions last <24 hours*)" alt="Urticaria (*Individual lesions last

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Urticaria (*Individual lesions last <24 hours*)

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localized, acute dermal edema

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Uritcaria

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localized, acute dermal edema geographic patterns

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Urticaria, cold induced

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localized, acute dermal edema

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Urticardia, cold induced

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localized, acute dermal edema

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Urticaria, pressure induced

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target lesions with rim of pallor and outermost zone of red

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(*Most often caused by HSV*)

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target lesions with rim of pallor and outermost zone of red

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(*Most often caused by HSV*)

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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Ixodes tick

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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reaction to internal malignancy

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Erythema gyratum repens

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reaction to distal infection? scaling trailing behind red border

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Erythema annular centrifugum

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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B. Papule palpable lesion, <10 mm

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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C. Patch

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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D. Plaque

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What is the type of lesion? A. Macule B. Papule C. Patch D. Plaque E. Ulcer

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E. Ulcer

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axilla distribution, *burrows*

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Scabies

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*burrows*

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Scabies

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*burrows*; finger web involvement

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Scabies

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RIGHT mite itself MIDDLE poop LEFT cyst

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Scabies

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Nodular Scabies

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hundred to thousands of mites

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Nodular Scabies

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pustules papulovesicles

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Fire Ant Sting

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nits

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Head lice

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Pubic Louse

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Body/Head Louse

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Tick

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Flea

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leg involvement not displaying "breakfast, lunch, and dinner" pattern

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Flea Bites

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necrotic ulceration

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Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

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necrotic ulceration

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Brown Recluse Bite (Note that Black Widow bites do not cause cutaneous lesions.)

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purple, polygonal, pruritic papules and plaques commonly seen on the wrists, genitalia, and buccal mucosa

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*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

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purple, polygonal, pruritic papules and plaques *Wickham's striae* (reticulated scaling) on the *buccal mucosa* also seen on the wrists and genitalia

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*Lichen Planus* (*Can progress to squamous cell carcinoma.*)

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"dew drops" without inflammation

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keratotic firm flesh-colored to red follicularly based papules seen on lateral arms, thighs, +/- cheeks

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Keratosis Pilaris

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flat-topped, asymptomatic, shiny papules seen on arms, dorsal hands, genitalia, and trunk

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Lichen Nitidus (Histology demonstrates a characteristic *ball and claw* pattern.)

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What other body parts does this "like?" A. Eye B. Feet C. Finger D. Mouth E. Scalp

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D. Mouth *Lichen planus "likes" the buccal mucosa, specifically.*

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Name the acne.

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Open comedonal (non-inflammatory) (Acne is caused by the gram positive anaerobe **Proprionibacterium acnes**.)

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Name the acne. ("Are you impressed by it?")

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Severe Nodulocystic Acne

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central facial erythema

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Acne Rosacea (Findings include facial erythema, telangiectasias, papules, and pustules. *Does not present with comedomes.* Rosacea is exacerbated by sun exposure, ethanol, and "flushing" agents.)

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usually in males with long history of sun exposure and ethanol consumption

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Rhinophyma (This is a complication of rosacea. Ocular symptoms include blepharitis, conjunctivitis, keratitis.)

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pustules on acne patient

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Gram Negative Folliculitis (Treat with ampicillin or augmentin.)

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*honey crusts* can have vesicles or bullae

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Impetigo (Caused by S. aureus or Streptococcus pyogenes.)

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beefy red eroded plaque, intertriginous areas *satellite pustules and papules*

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Satellite Candida (Associated with obesity and DM.)

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beefy red plaque, intertriginous areas *satellite pustules and papules*

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Satellite Candida (Associated with obesity and DM.)

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*lake of pus* with skin sloughing

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Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

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Type of acne? A. Comedonal B. Inflammatory C. Mixed D. Nodulocystic E. Rosacea

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A. Comedonal

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white, well demarcated plaque of induration with rim of hyperpigmentation perhaps some violaceous change

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*coup de sabre*

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shiny, swollen fingers difficulty opening mouth (beaked facies)

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superficial dilated blood vessels

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CREST Syndrome: Telangiectasias (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

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sausage digits, swollen, shiny

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CREST Syndrome: Raynaud's (Calcinosis of skin, Raynaud's, Esophageal dysmotility, Sclerodactaly, Telangiectasias; *positive for ANA, anti-centromere, negative for Scl-70.*)

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porcelain white; sharply demarcated with purpura; *cigarette paper* skin usually seen in genital area, but may be generalized

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Lichen Sclerosus (et atrophicus) (Commonly misdiagnosed as child abuse. Treat with high potency topical steroids with or without minocyclin/doxycycline.)

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annular papules/plaques with central clearing seen on the dorsal hands and feet

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Granuloma Annulare (Commonly diagnosed as *ringworm, which displays annular papules/plaques with scaling.*)

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red-brown to yellow plaques with prominent telangiectasias commonly seen on the shins

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Necrobiosis Lipoidica (Called "diabeticorum," as 2/3 of patients also have abnormal glucose metabolism.)

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What is the diagnosis? A. Granuloma annulare B. Morphea C. Necrobiosis lipoidica D. Lichen sclerosus E. Systemic sclerosis

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B. Morphea ("coup de sabre*)

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pinpoint to 3mm in size

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Petechiae (Most prominent in legs; if patient is bedridden, in back and sacrum.)

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ecchymoses; skin atrophy and bleeding usually seen on dorsolateral arms and dorsal hands

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Actinic ("Solar") Purpura (Chronic sun induces blood vessel fragility; loss of "shock absorbers" of the dermis. Skin atrophy and solar elastosis is usually severe.)

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eyelid purpura

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Systemic Amyloidosis (Also shows pinch purpura and macroglossia.)

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petechiae, purpuric stellate (irregular) ecchymosis; central necrosis most characteristic

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palpable purpura of the legs

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necrotic, hemorrhagic pustule on extremity may also present with swollen knee

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Gonococcemia caused by N. gonorrhoeae (Culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.)

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fairly well demarcated, hypopigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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fairly well demarcated, hyperpigmented atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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fairly well demarcated, erythematous atrophic plaques with fine scale usually seen on chest, back, and shoulders

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Tinea (Pityriasis) Versicolor (*Worse in hot/humid environments.*)

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*chopped spaghetti and meatballs* KOH stain

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Tinea (Pityriasis) Versicolor (Hyphae and spores can be seen.)

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periorificial, sharply marginated white (depigmented) non-scaly patches

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Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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periorificial, sharply marginated white (depigmented) non-scaly patches

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Vitiligo (Associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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process from hair follicle outward

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Repigmentation in Vitiligo (Vitiligo is associated with Grave's disease and autoimmune thyroiditis, pernicious anemia, alopecia areata, and Addison's disease.)

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hypopigmented poorly demarcated atrophic plaques with fine white scale. usually affects the cheeks; also commonly involves upper outer arms

1 year.)" alt="Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)">

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Pityriasis Alba (Usually first noticed in spring or summer. Repigmentation takes >1 year.)

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rim of hyperpigmentation at edge scarring in center

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subtle, somewhat well-demarcated scaly white patches/macules

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"ash-leaf" macule/patch

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4+ ash-leaf patches

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Shagreen patch "ash-leaf" patch

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adenoma sebaceum angiofibromas dental enamel pits

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Koenen's tumors

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What is the best diagnosis? A. ITP B. Leukocytoclastic vasculitis C. Neisseria infection D. Solar purpura E. TTP

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C. Neisseria infection Gonococcemia is the diagnosis; culture cervical/penile urethra, oropharynx, and rectum; treat with IV ceftriaxone.

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macules, "sprinkled confetti" seen on shins of females

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Idiopathic Guttate Hypomelanosis (No good therapy.)

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hypopigmented, hypestetic macule/patch/plaque

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Leprosy (Tissue biopsy for Fite stain. Caused by Mycobacterium leprae and spread by armadillos.)

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hypopigmented areas, bathing trunk distribution

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Hypopigmented Mycosis Fungoides (Cutaneous T-Cell Lymphoma.)

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Which of the following may be found in this patient? A. Cafe au lait macules B. Coup de sabre C. Neurofibromas D. Shagreen patch

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significant thinning of the parietal region no inflammation or scarring

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thinning of the vertex scalp

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no scarring or inflammation

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no scarring or inflammation

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vertex loss

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irregularly-shaped with variable hair length no scaling or erythema

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diffuse thinning "difficult to tell here"

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bizarre geometric shape

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oval/round patch, exclamation point hairs

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sharply demarcated, oval and smooth patch

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totalis

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Nonspecific nail pitting, here associated with Alopecia Areata

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erythema scaling some scarring, possibly

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lots of erythema scaling

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young children

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exclamation point young child

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Diagnosis in this 8 year old? A. Exzema B. Discoid Lupus erythematous C. Psoriasis D. Seborrheic Dermatitis E. Tinea capitis

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"crumbly nails" debris, yellow change DIFFERENTIAL psoriasis, trauma, lichen planus

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Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

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hallux involvement

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Onychomycosis (Most commonly caused by T. rubrum, T. mentagrophytes; physical exam shows yellow, thickening and dystrophy, subungual debris, superficial white changes.)

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onycholysis oil drop

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pitting

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nail and skin involvement pustules, "lakes of pus"

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Pustular Psoriasis (Most commonly limited to palms and soles. Treat with MTX or Soriatane.)

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red, swollen

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swollen

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180 degrees)" alt="Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)">

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Clubbing (Bulbous thickening of distal digit, proximal nail fold soft and thickened; hypertrophic osteoarthropathy; Lovibond's angle > 180 degrees)

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spoon-shaped

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transverse furrows affecting all nails

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What is the diagnosis? A. Beau's lines B. Clubbing C. Fungus D. Koilonychia E. Paronychia F. Psoriasis

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medial aspect of lower leg full thickness epidermal loss with petechiae (pinpoint - 3 mm)

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sharply demarcated, "punched out" ulcer

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cribriform scarring

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Chancre in Primary Syphilis (Note that the *chancre caused by Treponema pallidum is painless*, whereas the *chancroid caused by Haemophilus ducreyi is painful*.)

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dark field microscopy

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Spirochetes (You can test for the syphilitic Treponema pallidum by dark field microscopy.)

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*"nickles and dimes" on palm*

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Secondary Syphilis HIGHLY STRESSED)

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"moth-eaten" alopecia

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Secondary Syphilis

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"punched out, painful" ulcers

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Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

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painful, ragged ulcer "undetermined" NOTE difficult to culture

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Chancroid (This is caused by Haemophilus ducreyi, and should be differentiated from the chancre of primary syphilis, as caused by Treponema pallidum.)

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"school of fish" gram negative coccobacilli

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Haemophilis ducreyi (Causative agent of chancroid.)

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grouped ulcerations on erythematous base

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HSV

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grouped vesicles on erythematous base

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HSV

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Tzanck smear showing multinucleated keratinocytes, ballooning degeneration steel-gray nuclei chromatin margination

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HSV

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*angulated linear heme-crusted ulcer*

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What is the best diagnosis? A. Arterial ulcer B. Factitial ulcer C. Pyoderma gangrenosum D. Stasis ulcer E. Syphilis

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C. Pyoderma gangrenosum Note underlying edge, where "one could stick a probe."

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cheek, arms

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plaque, erythematous papules seborrheic appearance

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possible lichenification in the cubital fossa

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Eczema (Appearance is classically more ill-defined scaly erythematous coalescing papules and plaques; *childhood form favors flexors; often lichenified*; 40% have persistent disease as adults)

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hyperlinear palms

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thickening NOTE the papulovesicles on the lateral finger

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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Hand Dermatitis (Caused by contact irritant or allergy; can also be associated with foot/ feet dermatitis; related to atopic dermatitis)

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"plate-like or fish-like" changes dry river bed

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Asteatotic Eczema (Appearance is termed "eczema craquele" and "dried river bed;" favors shins, flanks, post axillary line. Associated with aging, xerosis, low humidity, frequent bathing)

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*coin-shaped*, scaly

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eye involvement linear pattern

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eczematous changes with vesicles

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scalp involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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intertrigious area

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eyebrow scaling

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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scalp and forehead involvement

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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brown, angular, ring shaped could be fungal

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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impressive scaling and redness over the face guttate (drop-like)

$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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$Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)$

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Seborrheic Dermatitis (Favors scalp, ears, face, central chest, and intertrigious areas; associated with with Malassezia Furfur [pitrysorom ovale]; can be severe and refractory in HIV)

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varicosities, venous ulceration pigmentary changes

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petechiae, ulceration, hyperpigmentation

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pigmentary changes only, longstanding

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Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

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spikiness; not all at same level vertical streaking of collagen *irregular epithelial hyperplasia* NOTE compare to psoriasis histology

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Lichen Simplex Chronicus (Secondary finding due to chronic rubbing and scratching; continued by *Itch-scratch-itch cycle*)

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irregular presentation linear heme crusts post inflammatory changes

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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old scarring from past flares angulated upper back only

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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linear scratches DIFFERENTIAL contact dermatitis

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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bizarre ulceration pattern

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Neurodermatitis (Neurodermatitis/Neurodermatology includes delusions of parasitosis, factitional disorders, and endogenous pruritus [kidney, liver, thyroid, anemia, lymphoma, parasites, other])

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sharply demarcated, erythematous papules, plaques, some annular (central clearing) not very much scaling truncal predominance

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sharply demarcated annular and erythematous papules and plaques truncal distribution

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papulosquamous eruption at scalp thick scaling

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papulosquamous eruption sharply demarcated scaly

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very erythematous swollen joints with potential arthritic changes

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*nail pitting* plaque on right

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onycholysis *oil drop*

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club shaped equal level NOTE compare to histology of lichen simplex chronicus

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*Monroe's microabscess* NOTE compare to histology of lichen simplex chronicus

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plaques, slightly scaly buttocks and lower trunk most affected

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orange/salmon color some scaling

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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annulare with scaling

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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segmented; hyphae in fungus

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Tinea (Use "capitis" for scalp, "manum" for hand, "pedis" for foot, "cruris" for groin area, "ungium" for nail, "corporis" for body- location 'not otherwise specified'.)

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What is the most likely diagnosis? A. Allergic contact dermatitis B. Candidiasis C. Eczema D. Psoriasis E. Tinea

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round, "punched out" ulcers yellow/white necrotic base with surrounding erythema

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uncommon oral ulcer

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Histoplasmosis

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uncommon oral ulcer

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Pemphigus Vulgaris (90% will develop oral ulcers, and 50% present with oral ulcers, may involve buccal mucosa or tongue.)

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uncommon ulcerative scarring of mucosa

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Mucosal/Cicatricial Pemphigoid

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blister on erythematous base

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Herpes Labialis

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blisters, erythema around it on hand

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Hand, Foot, Mouth Disease (Diagnosis especially likely if dermatologic findings are in a child.)

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Squamous Cell Carcinoma of the Lip

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Squamous Cell Carcinoma of the Tongue

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plaque

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plaque

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histologically appears like psoriasis

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Geographic tongue (Occurs after eating hot foods or drinking hot beverages; benign finding that will heal.)

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What is the best diagnosis? A. Candidiasis B. Cicatricial pemphigoid C. Herpes virus infection D. Pemphigus vulgaris E. Syphilis

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C. Herpes virus infection

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Is this lesion malignant? A. True B. False

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A. True Note the pearly color and presence of telangiectasias. This is a basal cell carcinoma.

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flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

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flesh-colores firm papules/nodules interrupts normal skin lines usually on hands, fingers

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Slightly raised, flat surfaced papule

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Flat Warts

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often covered by callus can be painful

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Plantar Warts

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soft, moist papule cauliflower-like

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Condyloma Acuminatum, the Venereal Wart (Appears as a soft, moist papule or plaque, can be sessile or pedunculated and is often cauliflower-like.)

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yellow-brown, well circumscribed, scaly papules not interrupting skin lines usually on feet and toes

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tan to dark brown; round and waxy *"stuck on"*, like you could peel it off

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tan to dark brown; round and waxy-appearing *"stuck on"*, like you could peel it off

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soft, *pedunculated* papule

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flesh-colored papules with smooth, folded surface in the axilla

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hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

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hard, smooth, dome-shaped flesh-colored central *umbilication with "cheesy" core*

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rough, yellowish adherent scale

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rough, yellowish adherent scale

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/actinic-keratoses-sun-spotsprecancerous-epidermal-neoplasm-caused-by-exposure-to-uv-light-appears-as-1-10-mm-wide-reddish-ill-defined-indistinct-borders-with-rough-yellowish-adherent-scale-o.jpg" title="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~< 1/1000 per year) develop into squamous cell carcinoma.)..." alt="Actinic Keratoses ("Sun Spots") (Precancerous epidermal neoplasm caused by exposure to UV light. Appears as 1-10-mm wide reddish, ill-defined indistinct borders with rough, yellowish adherent scale. Often easier felt than seen. Small number (~

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scaling, indurated nodule

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scaling plaque

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red, scaly, crusted and well-defined plaque

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Bowen's Disease (Squamous Cell Carcinoma in Situ)

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rapidly growing, crater-like nodule

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Keratoacanthoma (May involute, but difficult to differentiate from SCC, so treat regardless.)

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pearly, semitranslucent nodules central depression

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ulceration and crusting pearly appearance with telangiectasias

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pearly with rolled margin shiny blue-black color, speckled

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Pigmented Basal Cell Carcinoma

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pearly with telangiectasias blue-black color, speckled

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Pigmented Basal Cell Carcinoma

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red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

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Superficial Basal Cell Carcinoma

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red, slightly scaling, well-demarcated plaque DIFFERENTIAL eczema

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Superficial Basal Cell Carcinoma

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atrophic white plaque that looks like scar

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Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

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atrophic white plaque that looks like scar

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Sclerosing (Scarring) Basal Cell Carcinoma (Least common and most aggressive.)

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flesh-colored solitary nodule with central pore

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flesh-colored solitary nodule with central pore

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bright red lesion

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bluish lesion

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bright red, dome-shaped lesion

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Pinching shows central dimpling Light tan to dark brown

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dark brown, overlying hyperpigmentation and thickening

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dark brown elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

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pink elevated, firm, protuberant nodules/plaque usually appearing on earlobes, shoulders, upper chest, and back

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rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

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rubbery, flesh-colored nodule usually seen on trunk, neck, and upper extremities

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soft, flesh-colored, protruding papule or nodule DIFFERENTIAL skin tags

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large, deep, firm nodule "feels like a bag of worms"

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yellowish plaques on eyelids

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reddish-yellow papules and plaques

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potato-like nodules commonly seen on elbows, buttocks

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deep, flesh-colored, hard nodules located within peripheral tendons most commonly involving Achilles tendon and extensor fingers

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purple macules, papules, plaques, and nodules

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purple macules, papules, plaques, and nodules

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hyperpigmented macules

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Freckle/Ephelis (Sun-induced hyperpigmented macules that only occur in sun-exposed areas; very common. *Amount of melanin is increased*, but number of melanocytes stays the same.)

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hyperpigmented macules

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hyperpigmented macules

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light to dark brown macule

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brown, rough-surfaced papule

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flesh-colored smooth-surfaced papule

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variegated in color; irregular, indistinct border erythematous background

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variegated in color; irregular, indistinct border

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elevated, dark brown papule or plaque with discrete borders

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elevated, dark brown papule or plaque with discrete borders NOTE large congenital nevi (> 20cm) have increased chance of developing into melanoma

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irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

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irregular in color, surface, border may occur anywhere on body but show predilection for upper back in males and lower legs in females

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rapidly growing, blue-black, eroded nodule occur anywhere on the body

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rapidly growing, blue-black, smooth nodule occur anywhere on the body

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multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

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multicolored patch with some elevated areas; changes in size, growing slowly; darkening is insidious (years) occurs on sun-exposed skin

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irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

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irregular, enlarging, black growth occurs on palms, soles, toes or fingers DIFFERENTIAL lentigo maligna melanoma

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Main treatment is surgical excision, with increasing margins for increasing thickness.

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Survival Statistics Based on Melanoma Depth

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shiny, blue-black color, speckled rolled borders; waxy and cratered

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Pigmented Basal Cell Carcinoma

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irregular in color, surface, border

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Superficial Spreading Melanoma

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variegated in color; irregular, indistinct border

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Combined Melanocytic Nevus

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This vesicular eruption is caused by: A. HSV B. VZV C. Poison Ivy D. Streptococcus

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C. Poison Ivy Linear and geometric patterns usually have their source outside the body.

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grouped vesicles on erythematous base

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HSV (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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grouped vesicles on erythematous base fingers

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Herpetic Whitlow (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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generalized skin infection with predisposing skin disease

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Eczema Herpeticum (Grouped vesicles on erythematous base; can quickly become pustules that rupture and crust, which may result in ulcers.)

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Tzanck smear multinucleated giant cells

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HSV

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grouped vesicles in plaque

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Chronic HSV

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generalized, pruritic vesicular eruption various lesions (macules, papules, vesicles) "dewdrop on a rose petal"

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unilateral eruption of groups of vesicles along dermatome

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Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

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unilateral eruption of groups of vesicles along dermatome

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Zoster (Caused by reactivation of VZV in sensory nerve; can involve adjacent [*but not bilateral*] dermatomes. Post-herpetic neuralgia is more common in elderly and can be severe.)

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Superficial desquamation beginning.

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Superficial desquamation after toxic erythema.

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erythematous plaques, violaceous hue; sun exposure DIFFERENTIAL drug reaction

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sparing of the nasolabial folds; "butterfly rash"

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redness, warmth, swelling, pain intact epidermis blisters occur only rarely

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Cellulitis (displaying the four cardinal signs)

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Fungal Cellulitis (cannot determine cause by observation)

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sharply demarcated red plaque with orange peel appearance (follicles accentuated)

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associated hair follicle

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Furuncle

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no associated hair follicle fluctuates when pressed

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Abscess

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red, ill-defined nodules with bruise-like appearance on shins will be painful when touched

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Erythema Nodosa (Causes: Strep, OCPs, Pregnancy, or idiopathic)

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sharply demarcated red plaques, later dusky same lesion can reappear prefers the distal extremities, face, lips, and genitalia

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Fixed Drug Eruption (Causes: *NSAIDs, sulfonamides,* tetracyclines, carbamazepine)

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persistent flushing of the face due to high levels of 5HT

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Carcinoid Syndrome

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cutaneous metastases mimicking cellulitis painful, hot

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Carcinoma Erysipeloides

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slightly raised, some blanching at border edematous plaques

<img src="https://chmanchacentro.com/wp-content/uploads/2018/04/urticariaindividual-lesions-last.jpg" title="Urticaria (*Individual lesions last <24 hours*)" alt="Urticaria (*Individual lesions last

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Urticaria (*Individual lesions last <24 hours*)

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localized, acute dermal edema

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Uritcaria

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localized, acute dermal edema geographic patterns

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Urticaria, cold induced

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localized, acute dermal edema

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Urticardia, cold induced

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localized, acute dermal edema

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Urticaria, pressure induced

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target lesions with rim of pallor and outermost zone of red

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(*Most often caused by HSV*)

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target lesions with rim of pallor and outermost zone of red

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(*Most often caused by HSV*)

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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Ixodes tick

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slowly expanding, >5 cm red expanding plaque

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Erythema migrans (*Caused by Borrelia burgdorferi transmitted by Ixodes*, treat with doxycycline, amoxicillin, or ceftriaxone)

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reaction to internal malignancy

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Erythema gyratum repens

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reaction to distal infection? scaling trailing behind red border

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Erythema annular centrifugum

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Dermatology Pathology Slides from Lecture – Flashcards

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