How many skin lesions can you identify?

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Seborrheic dermatitis is caused by overactive sebaceous glands.
Seborrheic dermatitis is caused by overactive sebaceous glands.

The ability to recognize cutaneous lesion patterns is the key determinant for facilitating an accurate diagnosis of many dermatologic conditions.

As the largest and most visible organ of the body, the skin can manifest a range of conditions reflecting both internal and external causation. Reviewing the correct nomenclature for cutaneous lesion morphology and characteristics will help primary-care clinicians augment their skills in lesion description and knowledge of regional distribution.

Classifying dermatologic disorders based on lesion distribution, configuration, and color will enhance the clinician's ability to successfully manage skin, hair, and nail conditions while providing a heightened awareness of which patients to refer to a dermatologist.

An assessment of the characteristics of cutaneous lesions should be approached in a deliberate and methodical manner. Chart documentation of precise dimensions is important with many lesions and is especially helpful in assessing changes over time if there is no indication for immediate biopsy, removal, or therapy. Color digital photography augmented with a measuring device calibrated to the millimeter may provide useful information for baseline reference and consultation purposes.

The determination of lesion configuration and distribution helps the clinician narrow the possibilities to a focused list of differential diagnoses. The following descriptive terminology is used to identify a range of cutaneous disorders.

Configuration

Annular—Round or circular, ringlike; areas of central clearing and an advancing or active margin may be visible (Figure 1, see slideshow)

Arciform—Partial circles

Circinate—Round, circular

Iris or targetoid—Targetoid (bull's-eye) lesions of annular configuration with central color contrast, often appearing as a violaceous center with a pink halo separated by a pale ring

Linear—in a straight-line or line-like format

Polypoid— protruding from the surface; may be broad-based or pedunculated (having a stalk or stem) (Figure 2, see slideshow)

Serpiginous—Wandering, uneven borders

Zosteriform—Distribution in a dermatome-like fashion

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