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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Cutaneous squamous cell carcinoma'''
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Cutaneous squamous cell carcinoma]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''SCC in situ (Bowen's disease''')
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Squamous cell carcinoma in situ of skin|'''SCC in situ (Bowen's disease''')]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Scaly patch or plaque
* Scaly patch or plaque
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* In black individuals: legs, anus, areas of chronic inflammation
* In black individuals: legs, anus, areas of chronic inflammation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Presence of dotted +/- glomerular vessels
* White to yellowish surface scales
* Red-yellowish background color
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Keratinocytic dysplasia involving the full thickness of the epidermis  
* Keratinocytic dysplasia involving the full thickness of the epidermis  
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* In black individuals: legs, anus, areas of chronic inflammation
* In black individuals: legs, anus, areas of chronic inflammation
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* White circles
* White structureless areas
* Masses of keratin
* Hairpin and linear-irregular vessels
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Keratinocytic dysplasia involving the full thickness of the epidermis  
* Keratinocytic dysplasia involving the full thickness of the epidermis  
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* May be painful or pruritic
* May be painful or pruritic
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Keratoacanthoma'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Keratoacanthoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Small macule initially
* Small macule initially
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* Rapid growth (within weeks)
* Rapid growth (within weeks)
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Merkel cell carcinoma'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Merkel cell carcinoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Intracutaneous nodule
* Intracutaneous nodule
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* Usually in older patients with light skin tones
* Usually in older patients with light skin tones
|-
|-
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Basal cell carcinoma'''
| rowspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Basal cell carcinoma]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Nodular basal cell carcinoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Nodular basal cell carcinoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Papule
* Papule
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* Face
* Face
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Focused, bright red, and branching arborizing vessels
* Loosely arranged blue-gray dots
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Shiny white to red, translucent or opaque structureless areas
* Multiple small erosions
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* large, hyperchromatic, oval nuclei and little cytoplasm
* large, hyperchromatic, oval nuclei and little cytoplasm
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* Worsened by heat, sweating, or irritation from clothing  
* Worsened by heat, sweating, or irritation from clothing  
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Common nevus'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Nevus|Common nevus]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dome-shaped  nodules
* Dome-shaped  nodules
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Blue nevus'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Blue nevus]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Macules
* Macules
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* Most commonly develops in children, adolescents, and young adults.
* Most commonly develops in children, adolescents, and young adults.
|-
|-
| rowspan="6" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Melanoma'''
| rowspan="6" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Melanoma]]'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Melanoma in situ''' (Lentigo Maligna)
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Melanoma in situ''' (Lentigo Maligna)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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* Development of darker pigmentation, sharper borders, or nodular areas are signs of progression to lentigo maligna melanoma
* Development of darker pigmentation, sharper borders, or nodular areas are signs of progression to lentigo maligna melanoma
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Lentigo maligna melanoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Lentigo maligna melanoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Macule
* Macule
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* Usually in older individuals
* Usually in older individuals
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Superficial spreading melanoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Superficial spreading melanoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Macule
* Macule
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* Lateral (radial) growth before vertical (invasive) growth
* Lateral (radial) growth before vertical (invasive) growth
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Nodular melanoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Nodular melanoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Polypoid nodule
* Polypoid nodule
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* Two-thirds arise in normal skin, the rest in existing moles
* Two-thirds arise in normal skin, the rest in existing moles
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Acral lentiginous melanoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Acral lentiginous melanoma]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Macules
* Patches
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Dark brown to black
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Raised areas
* Ulceration
* Bleeding
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variable
* Variable
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Most common among dark skinned individuals
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Amelanotic melanoma'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Amelanotic melanoma]]'''
| style="background: #F5F5F5; padding: 5px;" |Color usually pink, purple or normal skin color
| style="background: #F5F5F5; padding: 5px;" |Color usually pink, purple or normal skin color
| style="background: #F5F5F5; padding: 5px;" |Usually have an asymmetrical shape with an irregular border
| style="background: #F5F5F5; padding: 5px;" |Usually have an asymmetrical shape with an irregular border
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*
*
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Solar lentigo'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Solar lentigo]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Multiple spots
* Multiple spots
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* Associated with UV exposure and skin aging
* Associated with UV exposure and skin aging
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Sebaceous hyperplasia'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Sebaceous hyperplasia]]'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Papules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Skin-colored to brownish
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Umbilicated
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Variable
* 2 - 6 mm
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Forehead
* Nose
* Cheeks
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Structureless yellow to whitish center surrounded by short linear "crown vessels"
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Usually in middle-aged or older patients
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Lichen planus-like keratosis'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Lichen planus-like keratosis'''
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Papule
* Plaque
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Gray to brown
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* Shows a coarse or fine, gray to blue, granular pigmentation
* Diffuse brownish gray granules
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
|-
|-
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''Actinic keratosis'''
| colspan="2" style="background: #DCDCDC; padding: 5px; text-align: center;" |'''[[Actinic keratosis]]'''
| style="background: #F5F5F5; padding: 5px;" |less pigmentation, and tend to be somewhat smaller in size.
| style="background: #F5F5F5; padding: 5px;" |less pigmentation, and tend to be somewhat smaller in size.
| style="background: #F5F5F5; padding: 5px;" |Erythema
| style="background: #F5F5F5; padding: 5px;" |Erythema

Revision as of 03:56, 19 February 2019

Diseases Physical exam Para-clinical findings Additional findings
Skin Examination
Diagnosis
Type Color Texture Size Distribution Dermoscopic Findings Histopathology
Cutaneous squamous cell carcinoma SCC in situ (Bowen's disease)
  • Scaly patch or plaque
  • Erythematous
  • Skin colored
  • Scaly
  • Variable
  • Fair-skinned individuals: sites frequently exposed to the sun
  • In black individuals: legs, anus, areas of chronic inflammation
  • Presence of dotted +/- glomerular vessels
  • White to yellowish surface scales
  • Red-yellowish background color
  • Keratinocytic dysplasia involving the full thickness of the epidermis
  • No infiltration into the dermis
  • Pleomorphic keratinocytes
  • Hyperchromatic nuclei
  • Grows slowly, enlarging over the course of years
Invasive squamous cell carcinoma
  • Papules
  • Plaques
  • Nodules
  • Skin colored
  • Indurated or firm, and hyperkeratotic (well-differentiated lesions)
  • Soft with ulceration or hemorrhage (poorly differentiated lesions)
  • 0.5 to 1.5 cm
  • Fair-skinned individuals: sites frequently exposed to the sun
  • In black individuals: legs, anus, areas of chronic inflammation
  • White circles
  • White structureless areas
  • Masses of keratin
  • Hairpin and linear-irregular vessels
  • Keratinocytic dysplasia involving the full thickness of the epidermis
  • No infiltration into the dermis
  • Pleomorphic keratinocytes
  • Hyperchromatic nuclei
  • May be painful or pruritic
Keratoacanthoma
  • Small macule initially
  • Papular and eventually forms a circumscribed nodule
  • May have telangiectasias
  • Skin-colored
  • Mildly erythematous
  • Prominent keratinous core in the center of the nodule
  • Variable
  • Sun-exposed areas
  • Usually face (especially the eyelids, nose, cheek, and lower lip), neck, hands, and arms
  • White circles
  • Keratin
  • Blood spots
  • White structureless zones
  • Well-differentiated squamous epithelium showing mild degrees of pleomorphism and forming masses of keratin that constitute the central core
  • Epidermal hyperplasia with large eosinophilic keratinocytes
  • Inflammatory infiltrate in the dermis
  • Rapid growth (within weeks)
Merkel cell carcinoma
  • Intracutaneous nodule
  • Shiny
  • Flesh-colored or bluish-red
  • Firm
  • Rapidly growing
  • Starts on Sun-exposed areas
  • Head and neck
  • Upper limbs and shoulder
  • Lower limbs and hip
  • Trunk
  • Milky red areas
  • Linear
  • Irregular vessels
  • Polymorphous vessels
  • Strands of uniform, round, blue cells, with large basophilic nuclei
  • Single-cell necrosis
  • Frequent mitoses
  • Lymphovascular invasion
  • Perineural invasion
  • Epidermal involvement via pagetoid spread
  • Usually in older patients with light skin tones
Basal cell carcinoma Nodular basal cell carcinoma
  • Papule
  • Flesh-colored
  • Variable
  • Face
  • Focused, bright red, and branching arborizing vessels
  • Loosely arranged blue-gray dots
  • May have a "rolled" border
Superficial basal cell carcinoma
  • Patch
  • Erythematous
  • Scaly
  • Variable
  • Shiny white to red, translucent or opaque structureless areas
  • Multiple small erosions
  • large, hyperchromatic, oval nuclei and little cytoplasm
  • well differentiated and cells appear histologically similar to basal cells of the epidermis
Prurigo nodules
  • Dome-shaped nodules
  • Flesh-colored
  • Erythematous
  • Brown/black
  • Firm
  • Few millimeters to several centimeters
  • Extensor surfaces of the arms and legs and on the trunk
  • Upper back, abdomen, and sacrum
  • Thick, compact orthohyperkeratosis
  • Irregular epidermal hyperplasia
  • Focal parakeratosis with irregular acanthosis
  • A nonspecific dermal infiltrate containing WBCs
  • Nodules range in number from few to hundreds
  • Worsened by heat, sweating, or irritation from clothing
Common nevus
  • Dome-shaped nodules
  • Hypopigmented
  • Smooth surface
  • Terminal hairs often present
  • Variable
  • Comma-shaped or curved vessels
  • Structureless light brown background
  • Residual brown thick circles around the hair follicles
Blue nevus
  • Macules
  • Papules
  • Blue
  • Variable
  • Head and neck,
  • Dorsal aspect of the distal extremities
  • Sacral area
  • Structureless blue pigmentation
  • Structureless blue and white or blue and brown on some occasions
Spitz nevus Nonpigmented Spitz nevus
  • Nodules
  • Pink
  • Variable
  • Cheek
  • Coiled vessels
  • White network over a pink to reddish background
  • Most commonly develops in children, adolescents, and young adults.
Reed-like Spitz
  • Papule
  • Heavily pigmented
  • Variable
  • Structureless black to gray center
  • Hypopigmented follicular openings
  • Peripheral streaks
  • Pseudopods
  • Globules
  • Most commonly develops in children, adolescents, and young adults.
Melanoma Melanoma in situ (Lentigo Maligna)
  • Macule
  • Variable (from light to dark brown, black, pink, red, or white)
  • Smooth
  • Around 1 cm
  • Sun-damaged skin of the head or neck
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
  • atypical spindle shaped melanocytes,
  • Arranged in single cells or in small nests along the dermoepidermal junction
  • Development of darker pigmentation, sharper borders, or nodular areas are signs of progression to lentigo maligna melanoma
Lentigo maligna melanoma
  • Macule
  • Brown/tan
  • Freckle-like
  • Variable
  • Chronically sun-damaged areas
  • Asymmetric, pigmented follicular openings
  • Gray angulated lines
  • Gray areas, dots, and globules
  • Circle within a circle
  • "Star-burst giant cells" at the basal layer of the epidermis
  • Poorly cohesive or dyshesive nests along the dermal-epidermal junction forming the "swallow's nest" sign
  • Cytoplasm is shrunken and surrounds a pale nucleus with small nucleoli
  • Usually in older individuals
Superficial spreading melanoma
  • Macule
  • Plaque with irregular borders
  • Variably pigmented (red, blue, black, gray, and white)
  • Thin
  • 1 mm to > 1 cm
  • Anywhere but most commonly:
    • Back (men and women)
    • Lower extremities (women)
  • Asymmetric
  • Poorly circumscribed
  • Lack cellular maturation
  • Lateral (radial) growth before vertical (invasive) growth
Nodular melanoma
  • Polypoid nodule
  • Dark color
  • Variable
  • Cells proliferate downwards through the skin
  • Dermal growth in isolation or in association with an epidermal component
  • Two-thirds arise in normal skin, the rest in existing moles
Acral lentiginous melanoma
  • Macules
  • Patches
  • Dark brown to black
  • Raised areas
  • Ulceration
  • Bleeding
  • Variable
  • Palmar
  • Plantar
  • Subungual
  • Mucosal surfaces
  • Most common among dark skinned individuals
Amelanotic melanoma Color usually pink, purple or normal skin color Usually have an asymmetrical shape with an irregular border Red, nonspecific lesion with slightly elevated borders
  • Do not make melanin, so lesions are not pigmented
Solar lentigo
  • Multiple spots
  • Brown
  • Around 5mm
  • Faint pigmented fingerprint structures
  • Structureless pattern
  • Light brown pseudonetwork with well-defined borders and a "moth-eaten" edge
  • melanin deposition in keratinocytes
  • linear arrangement of melanocytes at the dermoepidermal junction.
  • Associated with UV exposure and skin aging
Sebaceous hyperplasia
  • Papules
  • Skin-colored to brownish
  • Umbilicated
  • 2 - 6 mm
  • Forehead
  • Nose
  • Cheeks
  • Structureless yellow to whitish center surrounded by short linear "crown vessels"
  • Usually in middle-aged or older patients
Lichen planus-like keratosis
  • Papule
  • Plaque
  • Gray to brown
  • Variable
  • Shows a coarse or fine, gray to blue, granular pigmentation
  • Diffuse brownish gray granules
Seborrheic keratosis
  • Variable
Actinic keratosis less pigmentation, and tend to be somewhat smaller in size. Erythema Hyperkeratosis painful

SCC in situ: Frequently, there is associated thickening of the epidermis (acanthosis), as well as hyperkeratosis and parakeratosis of the stratum corneum. In contrast to SCC in situ, actinic keratoses demonstrate only partial-thickness epidermal dysplasia.