Diagnosis, Exam and Distribution
Primary Lesion Examples
Dermatologic Procedure Videos #9–#14: Cryosurgery
Secondary Lesion Examples
Description of Lesions
Lesion Examples by Description
Morphologic Variation, Time Course and Age
Put what you've learnt to the test. Identify, diagnose, and treat these real world patients.
Physical Exam & Dermatologic Diagnosis
Updated April 1, 2021
2.2 contact hours
- Key elements of a dermatologic exam
- Specific vocabulary of lesion morphology
- Systematic evaluation & search for lesion morphology & pattern recognition
- Search for “primary” & “secondary” lesions with pattern recognition will lead to correct diagnosis
- Identify how factors (immune status, skin type) affect lesion morphology
- Time course of development of skin problem can change exam findings, namely the clinical horizon
33,000 Mohs surgery cases for skin cancer | Director for accredited ACGME procedural dermatology fellowships
Put what you've learned to the test - take the Physical Exam & Dermatologic Diagnosis quizzes below.
Dermatologic exam based on objective, observable exam findings as follows:
Distribution - where is rash anatomically
- unilateral vs. bilateral
- sun exposed
- flexural, extensor
Primary Lesions - must correctly identify to make a correct diagnosis or be in disease group.
- Macule: lesions are visible only and have no palpable quality
- Plaque: an elevated lesion that is palpable
- Papule: raised bump measures < 1cm or <0.5cm; different descriptors (e.g. flat-topped, polygonal, follicular, perifollicular, compressible, verrucous, umbilicated
- Nodule: larger papule 0.5cm-2.0cm
- Tumor: palpable lesion >2.0cm
- Wheal: edema in skin producing a peau d’orange
- Vesicle: any fluid-filled lesion < 0.5cm in diameter
- Bullae: fluid-filled blister >0.5cm in diameter
- Pustule: vesicle containing pus
- Cyst: a collection of fluid or solid debris within a defined sac
- Telangiectasia: a superficial blood vessel that has enlarged enough to be visible
- Comedone: noninflammatory acne lesion due to obstruction of the pilosebaceous opening
Secondary Lesions - changes that occur to or are associated with primary lesions.
- pigmentation change
Descriptions of Lesions - specific visual clues that describe unique clinical exam findings often associated with particular skin lesions or diseases.
- targetoid / serpiginous / nummular / linear / follicular
Morphologic Variation - factors that can affect the morphologic appearance of lesions.
- Time course and clinical horizon, depending upon when in the timeline of skin disease development the patient presents. Patients who present before essential, key elements of a skin disease develop (i.e. below the clinical horizon) are more difficult to diagnose.