Expansion
Site, distribution, morphology, colour, border, surface and secondary change
Expansion
Primary lesions
| Term | Definition |
|---|---|
| Macule | Flat, under 1 cm, colour change only |
| Patch | Flat, over 1 cm |
| Papule | Raised, under 1 cm |
| Nodule | Raised, over 1 cm, deeper |
| Plaque | Raised, flat topped, over 1 cm |
| Vesicle | Fluid filled, under 5 mm |
| Bulla | Fluid filled, over 5 mm |
| Pustule | Pus filled |
| Weal | Transient raised oedematous swelling |
Secondary change: scale, crust, excoriation, lichenification, fissure, erosion (epidermis only), ulcer (through the dermis), scar, atrophy.
What to describe
- Site and distribution: symmetrical, extensor or flexor, photodistributed, dermatomal, acral, follicular
- Number and arrangement: solitary, grouped, linear, annular, target
- Size and shape
- Colour, and whether it blanches; a non-blanching purpuric rash is the one that must never be missed
- Border: well or poorly defined
- Surface: smooth, scaly, crusted, warty
- Palpation: temperature, tenderness, consistency, depth
- Nails, scalp, mucous membranes and the whole skin surface
ABCDE for a pigmented lesion suspicious of melanoma: Asymmetry, Border irregularity, Colour variation, Diameter over 6 mm, Evolution or elevation. Change is the single most important feature.
Fitzpatrick skin type affects appearance; erythema may be difficult to see and presents as violaceous or grey in darker skin, and this is a common source of delayed diagnosis.