Integumentary System

• Macule


  Pigmented, non-palpable, small spot, Ex. freckles (ephelides), measles, petechiae
• Patch


  Large macule greater than 1 cm in diameter, Ex. vitiligo
• Papule


  Circumscribed border up to 0.5 to 1 cm, Ex. papule of an acne, moles (nevus), warts (common warts, e.g., verruca vulgaris)
• Plaque


  Elevated flat surface larger than 0.5 to 1 cm, Ex. xanthelasma of the eyelids, psoriasis
• Nodule


  Larger than 0.5 cm; often deeper and firmer than a papule, Ex. lipoma, squamous cell carcinoma, fibroma
• Cyst


  Elevated, encapsulated, fluid-filled, or semi-solid mass originating in the subcutaneous tissue or dermis, usually 1 cm or larger, Ex. sebaceous cyst and epidermoid cyst
• Tumor


  Large nodule, Ex. neurofibroma, hemangioma
• Primary Lesions


  • Circumscribed, flat, non-palpable
  • Palpable, elevated, solid mass
  • Circumscribed superficial elevations of the skin
• Tumor


  Large nodule, e.g. a large neurofibroma, hemangioma
• Circumscribed superficial elevations of the skin with fluid

  • Vesicle - up to 0.5 cm, elevated, filled with serous fluid, e.g. poison ivy, chicken pox, herpes simplex
  • Bulla - greater than 0.5 to 2 cm, filled with serous fluid, e.g. 2nd-degree burn, friction blisters, bullous pemphigoid
  • Wheal - elevation, often reddish with irregular border caused by diffused fluid in tissue rather than the free fluid in a cavity, as in vesicles, raised firm lesions with intense localized skin edema varying in size and shape and transient occurrence, disappears in hours, e.g. insect bites and hives
  • Pustule - filled with pus, e.g. acne, impetigo, carbuncle
• Loss of skin surface

  • Erosion - causes a moist, shallow depression, heal without scarring, loss of superficial epidermis, leaving a moist area that does not bleed, e.g. skin surface after a ruptured vesicle, scratch marks
  • Ulcer - irregularly shaped extending into the dermis or subcutaneous tissues, deeper loss of surface that may bleed and scar, e.g. syphilitic chancre, ulcer of venous insufficiency, stasis ulcer
  • Fissure - a linear crack, e.g. athlete's foot
• Material on the skin surface

  • Crust - the dried residue of serum, pus, or blood, e.g. a scab following abrasion; impetigo
  • Scale - shedding flakes of greasy, keratinized skin tissue, color may be white, gray, or silver, texture may vary from fine to thick, could also be a thin flake of exfoliated epidermis, e.g. dry skin, dandruff, psoriasis
  • Lichenification - a rough, thickened, hardened area of epidermis resulting from chronic irritation such as scratching or rubbing, e.g. chronic atopic dermatitis
  • Scar - a flat, irregular area of connective tissue left after a lesion or wound has healed, new scars may be red or purple, older scars may be silvery or white, e.g. healed surgical wound or injury, healed acne
  • Keloid - an elevated, irregular, darkened area of excess scar tissue caused by excessive collagen formation during healing, extends beyond the site of the original injury, higher incidence in people of African descent, e.g. keloid from ear piercing or surgery
• Absent - vitiligo, albinism
• Bronze/Tanning - addison’s disease, hemochromatosis
• Cherry - carbon monoxide poisoning
• Dusky-blue - arsenic poisoning, cyanosis, hypoxemia, heart or lung disease
• Pallor - anemia, vitiligo, albinism
• Petechiae - leukemia, endocarditis, scarlet fever, viral hemorrhagic fever
• Pink/Red - erythema, direct trauma, alcohol intake, fever
• Red - polycythemia, erythema, fungal infection
• Tan brown - chloasma, suntan
• Yellow - uremia, hemolysis, liver disease, carotenemia
• Lesions - any pathologic skin change or occurence
• Basal Cell carcinoma - most common, waxy border; papule, red, central crater; metastasis is rare
• Squamous cell carcinoma - 2nd most common; oozing, bleeding, crusting lesions; potentially metastasis; large tumors associated with a higher risk of metastasis
• Melanoma - least common; irregular, circular, bordered lesions with hues of tan, black, or blue; rapid infiltration into tissue, highly metastatic
• first degree durn - superficial thickness; epidermis is injured or destroyed
• 2nd degree burn - partial thickness; the epidermis and upper layer of dermis are destroyed
• 3rd degree burn - full thickness; epidermis and dermis are destroyed
• 4th degree burn - full thickness; epidermis and dermis are destroyed; subcutaneous muscle and bone may be injured
• Stage 1 - non-blanchable erythema of intact skin; the epidermis remain intact
• stage 2 - shows partial-thickness skin loss involving the epidermis, dermis, or both
• stage 3 -full-thickness skin loss involving damage to or necrosis of subcutaneous tissue
• stage 4 - full-thickness skin loss with extensive destruction, tissue necrosis, or damage to the muscle, bone, or supporting muscles
• finger pads - use to check for skin moisture
• Lift a fold of skin - to check for skin turgor
• dorsum - used to check for temperature
• melanin - provides skin color
• melanocytes - produces melanin
• desquamation - skin shedding