Evaluation of skin and subcutaneous tissue disease

February 22, 2013 | By | Reply More

Evaluation of skin and subcutaneous tissue disease

Assessment and description of a lump
Key features in the history include the following.
  • Speed of development. Rapid increase in size is suspicious of malignancy (primary or secondary).
  • Recent change in size suggests malignant change or infection in a previously benign lesion.
  • Associated symptoms. Paraesthesia or weakness suggests involvement of nerves; reduced movement suggests involvement of muscle.
  • History of local trauma may indicate a cause, although a previously undiagnosed underlying lump should always be suspected.
The following features should all be considered when examining the lump.
Basic facts
  • Position.
  • Size.
  • Shape.
Features of infection or inflammation
  • Temperature.
  • Tenderness.
  • Colour.
Features of malignancy
  • Surface (e.g. craggy).
  • Edge (e.g. irregular).
  • Consistency (e.g. hard).
Features of fluid or vascular lesions
  • Fluctuant (fluid-filled).
  • Presence of thrill (fluid-filled).
  • Transilluminance (fluid-filled).
  • Pulsatile (arterial lesion).
  • Presence of a bruit (arterial lesion).
  • Presence of expansility (indicative of an arterial aneurysm).
  • Presence of compressibility (e.g. venous lesion or arteriovenous malformation).
Features of locoregional invasion
  • Tethering to surrounding structures.
  • Involvement of surrounding structures (e.g. nerves).
  • Regional lymphadenopathy.
Assessment and description of an ulcer
Key features in the history include the following:
  • Is it painful (venous, diabetic, and neuropathic ulcers are painless)?
  • Did it start as an ulcer or did a lump become ulcerated (suggests a malignancy in/of the skin)?
  • Is there a history of underlying infection, e.g. of bone?
Describe the basic morphology of the ulcer.
  • Location.
    • Over pressure points and bony prominences suggests pressure sore.
    • Medial shin suggests venous ulcer.
    • Lateral shin, dorsum of foot, toes suggest arterial ulcer.
  • Edge.
    • Sloping edge suggests conventional ulcer (can be many aetiologies).
    • Rolled edge is typical of basal cell or squamous carcinomas.
    • Everted edge suggests squamous or metastatic carcinomas.
    • Vertical edge (punched out) suggests syphilis or chronic infection.
  • Base.
    • Friable, red, and bleeding suggests venous or traumatic.
    • Green slough suggests infected.
    • Black hard eschar suggests chronic ischaemia.
  • Discharge. May suggest an underlying cause, e.g. intestinal fistula with enteric content, golden pus in chronic actinomycosis.
  • Surrounding tissue. Erythema and swelling suggest secondary infection.

Category: Surgery

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