1. Morphology and Differential Diagnosis

2. Welcome to Dermatology! No matter what area of medicine or surgery you pursue, you will get skin related questions from family, friends, and patients. The time frame is short, so make the best use of your time. Carry your book with you at all times and try to make it through all the photos.

3. Suggestions for a Successful Rotation Be on Time! Be attentive and helpful. Do not ask questions or make comments during the patient encounter. Please ask all questions outside the exam room. Please do not talk loudly in the hallway.

4. Macule

7. Patch

8. Papule

9. Papules

12. Plaque

15. Nodule

18. Tumor

21. Pustule

23. Vesicle

26. Bulla

31. Wheals

33. Special Skin Lesions Burrow: Thin linear papule or plaque Comedone: Follicular papule filled with keratinous plug which is open or closed Cyst: Papule or nodule filled with debris Telangiectasia: Dilated blood vessel less than 1 mm wide

34. Burrow

35. Comedone

36. Telangiectasia

37. Cyst

38. Secondary Lesions Scale Crust Erosions and ulcers Excoriations Fissures Scars Lichenification Atrophy

39. Scales

42. Crust

44. Excoriations

45. Erosion

47. Ulcer

50. Fissure

53. Atrophy

57. Scar

60. Lichenification

61. Configuration Annular Arcuate Geographic Discrete Confluent Serpiginous Linear Reticulated

62. Annular and arcuate

63. Linear

64. Erythema Subitum

65. Descriptors Punctate Lichenoid Umbilicated Scarletiniform, morbiliform Leonine

67. Color Pink Violet Orange Blue Green Yellow Black Brown

68. Color PinkPityriasis rosea VioletLichen planus OrangeJuvenile xanthogranuloma BlueAmioderone skin pigmentation GreenPseudomonas YellowXanthomas Blackeschar BrownCafé au lait spots

69. Color

70. Distribution

71. Morphologic categories Macular-Patch Papular Papulosquamous (scaly papules) Nodular Pustular Vesicular-bullous Urticarial Petechial Telangiectatis Burrow Poikiloderma Hyperkeratotic/scale Atrophic

72. More is missed by not looking than by not knowing M. McKay, M.D.

73. Procedures Liquid Nitrogen Electrodessication and curettage Biopsy –Punch –Shave –Excision

78. Seborrheic Keratosis Common Skin Tumor of unknown cause. Predilection for trunk, scalp, temples No malignant potential Increase incidence with age Easily treated with curettage or cryodestruction

79. Dermatosis Papulosa Nigra Most likely a subtype of seborrheic keratosis Malar areas, most commonly on African- American women

80. Acrocordons (Skin Tags) Common, occurring in about 25% of adults More common in obese individuals and often develop in pregnancy Frictional areas such as neck, axillae, inframammary and groin locations Can become irritated or infarcted because of torsion

81. Dermatofibroma Firm papule often with brown pigmentation, most frequently seen on the anterior legs Dimple sign May be a reactive process to an insect bite reaction rather than a tumor If multiple, sometimes associated with systemic lupus erythematosis

82. Dermatofibroma

83. Keloids Hypertrophic scar which extends beyond the area of injury May have delayed onset, even up to years after injury Can be painful More common in African- Americans Treatment can be difficult and choices include intralesional steroids, radiation, careful excision, laser ablation

85. Epidermoid Cyst

86. Trichilemmal (Pilar) Cyst

87. Actinic Keratosis

88. Keratosis Pilaris Follicular papules, commonly on extremities sandpaper feel 20% of the population affected Worsens in adolescence Common in Atopics and icthyosis May improve with keratolytics, retinoids, dermabrasion

89. Keratosis Pilaris

91. Cherry Angiomas Benign vascular proliferation senile hemangioma – dont use this term with patients Usually appear on trunk, start at age 30, increase with age Dilated capillaries Tx for cosmetic reasons only