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Module title = Tutorial: Derm Morphology
Lesson title = Introduction to Morphology
This is lesson 2 of 18 in this module
Objectives
What does morphology mean?
Review the basic dermatological morphology vocabulary
Introduction
Morphology –referring to the structure and appearance of an object
Consider it the “language” of dermatology
In dermatology, morphology is used to
describe
the appearance of the skin, or specific lesions
Morphology does not describe the function of a lesion or the underlying pathological process but can be an indicator of
where
in the skin the pathology lies
There are primary and secondary morphological terms:
Primary
morphological terms—describe the main component of the lesion
Secondary
morphological terms—enhances the primary description by adding more detail
Please note**
: You can have a secondary morphology
without
a primary morphology. For instance, an ulcer may be present (a secondary morphology classification); however, there is no primary morphology visible or it has been destroyed by the secondary morphology. In these cases you can just use secondary morphology to describe a lesion without mentioning a primary morphology.
Examples of Primary vs Secondary Morphologies
Primary Morphologies
Secondary Morphologies
Macule
Crust
Papule
Scale
Patch
Fissure
Plaque
Erosion
Nodule
Ulceration
Vesicle
Excoriation
Bulla
Atrophy
Pustule
Lichenification
Palpable:
palpable refers to anything that can be felt—regardless of whether it is raised as in a papule or plaque, or depressed such as an atrophic scar.
If you closed your eyes and ran your fingers over the skin pathology, would you feel it was there? If yes, the lesion is “palpable”
Other details for describing a skin lesion
Colour is extremely important
Blanchable: if you press on a red/purple colored lesion, does it turn pale and then return to original color? If yes, it is blanchable.
a blanchable lesion indicates that the lesion is comprised of blood vessels or has a component of vasodilation. Pressing on the lesion squeezes the blood out of the vessels, results in a temporary pale appearance before the blood returns to the blood vessels
Location—where is the skin pathology on the body?
Shape—
circular = in a circle
linear = in a line
targetoid = like a target
ovoid = like an oval
stellate= like a star
Number—is there just one skin lesion or multiple
Distribution—
flexural areas = the folds (ie, axilla, inguinal, inframmamary)
extensor = the side of a limb or joint to which the movement of extension is directed (ie, the anterior thigh, the dorsal arm)
dermatomal = An area of skin supplied by sensory neurons arrving from the spinal nerver ganglion. In dermatology, if a rash is in a dermatomal distribution, it suggests the pathology may be related to the nerve root supplying the affected area
generalized = not specific, found all over
Taking a dermatology history:
Please note: the history is guided by what the lesion looks like, the distribution, and the colour. Once you get familiar with different dermatologic diagnoses you will be more focused with your history to rule out certain things arising in a particular distribution or pattern. Very broadly, some good questions to ask are:
1) When did the rash/lesion start and how did it progress?
2) Any trigger you can identify for the rash/lesion starting?
2) Does it come and go or is it fixed (stays where it arose and doesn't leave)?
3) Is it symptomatic, ie, are they itchy, painful, burning?
4) Does it bleed?
5) Any associated symptoms (ie, fever, weight loss, diarrhea, abdominal pain)?
6) What treatments have been tried?
7) Have any treatments worked?
Lesson 2 of 18
That was the last lesson!