Morphology:
How to describe what you see
Basic Dermatology Curriculum
Last updated July 16th, 2013
Goals and Objectives
▪ The purpose of this module is learn how to
best describe skin lesions
▪ After completing this module, the learner will
be able to:
• Develop a systematic approach to describing
skin eruptions
• Utilize the appropriate terms to describe
morphology
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Morphology
▪ The word morphology is used by dermatologists to
describe the form and structure of skin lesions
▪ The morphologic characteristics of skin lesions are
key elements in establishing the diagnosis and
communicating skin findings
▪ There are two steps in establishing the morphology of
any given skin condition:
1. Careful visual and tactile inspection
2. Application of correct descriptors
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Visual and Tactile Inspection
▪ Accumulate detailed information about the
visual and tactile aspects of the skin findings
▪ Be able to communicate an accurate
description so someone on the other end of a
phone can get a mental picture of what you
see.
▪ Question 1
• How would you fill in the description of the item
depicted on the next slide?
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Question 1
• How would you
describe the object to
the right?
• Be as detailed as you
can be!
Question 1
This is a red, circular,
shiny object with a
small invagination on
top. It measures 8 cm.
It is in a white
background and casts
a shadow.
The shadow tells us it is
raised (palpable).
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Question 1
• This is a red, circular, shiny object with a small
invagination on top. It measures 8 cm. It is in a white
background and casts a shadow.
▪The above description identifies:
1.Palpability (indicated by shadow)
2.Color
3.Shape
4.Texture
5.Size
6.Location
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Application of the correct
descriptors
• We have just reviewed careful visual inspection
• We will now define the terms dermatologists use to describe
skin lesions
• We will then have a series of cases for you to practice
describing so you can use the correct descriptors.
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Primary lesion: Macule
▪ (L. macula, “spot”)
▪ A macule is flat; if you
can feel it, then it is not
a macule.
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Examples of Macules
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Primary lesion: Patch
▪ Patches are flat but
larger than macules
▪ If it’s flat and larger
than 1 cm, it is a
patch
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Examples of Patches
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Primary lesion: Papule
▪ (L. papula, “pimple”)
▪ Papules are raised
lesions less than 1 cm
▪ It is caused by a
proliferation of cells in
epidermis or superficial
dermis
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Examples of Papules
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Primary lesions: Plaque
▪ Plaques > 1 cm
• You can feel them
• They cast a shadow with
side lighting
▪ It is also caused by a
proliferation of cells in
epidermis or superficial
dermis
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Examples of Plaques
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Nodule
▪ (L. nodulus, “small
knot”)
▪ It is caused by a
proliferation of cells
into the mid-deep
dermis
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Examples of Nodules
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Primary lesion: Vesicle
▪ (L. vesicula, “little
bladder”; bulla,
“bubble”)
▪ Vesicles are fluid-filled
papules (small
blisters)
▪ A large (> 1cm) blister
is called a bulla
20 vesicle bulla
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Examples of Vesicles
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Pustule
▪ Pus is made up of
leukocytes and a
thin fluid called
liquor puris (L.
“pus liquid”)
▪ See also furuncle
and abscess
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Erosion
▪ Erosions are loss of part
or all of the epidermis
▪ They may occur after a
vesicle forms and the top
peels off
▪ They weep and become
crusted
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Ulcer
▪ (L. ulcus, “sore”)
▪ Ulcers are complete loss of the
epidermis in addition to part of the
dermis
▪ They often heal with scarring;
erosions usually do not heal with
scars
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Review: Seeing the skin
▪ To describe what you see on the skin, first
determine the primary lesion
• Is it raised, flat, or depressed?
• Is it small or large?
• Is it fluid-filled?
▪ The table in the next slide summarizes most of
the terms used to describe the skin. We have
already reviewed many of them. Click on the
others to learn more.
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Terms
Raised Flat Depressed Fluid-filled Vascular
Papule Macule Erosion Vesicle Telangiectasia
Plaque Patch Ulcer Bulla Petechiae
Nodule Atrophy Pustule Ecchymosis
Tumor Sinus Furuncle
Wheal Stria Abscess
Burrow
Scar
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Review: Seeing the skin
▪ In your descriptions, include adjectives that
help describe the primary lesions. Make sure
to consider:
▪ Size
▪ Shape
▪ Color
▪ Texture
▪ Configuration
▪ Distribution
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Take Home Points
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Take Home Points
▪ To describe the skin, first inspect closely
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Take Home Points
▪ To describe the skin, first inspect closely
▪ Second, determine if the lesion is raised, flat, or
depressed and its size.
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Take Home Points
▪ To describe the skin, first inspect closely
▪ Second, determine if the lesion is raised, flat, or
depressed and its size.
▪ Then pick the term for the lesions that fits best!
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Take Home Points
▪ To describe the skin, first inspect closely
▪ Second, determine if the lesion is raised, flat, or
depressed and its size.
▪ Then pick the term for the lesions that fits best!
▪ Finally, use adjectives relating to the shape, color,
texture, distribution, and configuration to further
describe the lesion.
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Take Home Points
▪ To describe the skin, first inspect closely
▪ Second, determine if the lesion is raised, flat, or
depressed and its size.
▪ Then pick the term for the lesions that fits best!
▪ Finally, use adjectives relating to the shape, color,
texture, distribution, and configuration to further
describe the lesion.
▪ See the resources at the end for further reading.
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Acknowledgements
▪ This module was developed by the American Academy of
Dermatology’s Medical Student Core Curriculum Workgroup
from 2008-2012.
▪ Primary authors: Patrick McCleskey, MD, FAAD; Peter A.
Lio, MD, FAAD; Jacqueline C. Dolev, MD, FAAD; Amit Garg,
MD, FAAD.
▪ Peer reviewers: Heather Woodworth Wickless, MD, MPH;
Ron Birnbaum, MD; Timothy G. Berger, MD, FAAD.
▪ Revisions: Sarah D. Cipriano, MD, MPH, Jessica
Kaffenberger, MD, Joslyn Kirby, MD. Last revised July 2013.
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Resources
▪ Berger T, Hong J, Saeed S, Colaco S, Tsang M, Kasper R. The Web-
Based Illustrated Clinical Dermatology Glossary. MedEdPORTAL; 2007.
Available from: www.mededportal.org/publication/462.
▪ Morphology illustrations are from the Dermatology Lexicon Project,
which is now maintained by the American Academy of Dermatology as
DermLex.
▪ Dolev JC, Friedlaender JK, Braverman, IM. Use of fine art to enhance
visual diagnostic skills. JAMA 2001; 286(9), 100-2.
▪ Habif TP. Clinical Dermatology: a color guide to diagnosis and therapy,
4th ed. New York, NY: Mosby; 2004.
▪ James WD, Berger TG, Elston DM. Andrews’ Diseases of the Skin, 11th
ed. Elsevier; 2011:12-17.
▪ Marks Jr JG, Miller JJ. Lookingbill and Marks’ Principles of
Dermatology, 4th ed. Elsevier; 2006.
▪ Review primary lesions and other morphologic terms at http://
www.logicalimages.com/educationalTools/learnDerm.htm.
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