Primary Lesion - A primary lesion is directly associated with the disease process and is described

with established dermatological terminology. Identifying the primary lesion(s), whenever possible, is
the first step towards identification of the disease or cutaneous process. Primary lesions include
the macule, papule, patch, plaque,vesicle, bulla, nodule, tumor, wheal,
and pustule. Secondary lesions are a modification of primary lesions.

Macule - A circumscribed
flat area less than 1 cm
of discoloration without
elevation or depression of
surface relative to
surrounding skin.

Plaque - A wellcircumscribed, elevated,

superficial, solid lesion,
greater than 1 cm in
diameter.

Papule - A
circumscribed,
elevated, solid lesion,
less than 1 cm.

Vesicle - A small,
superficial,
circumscribed
elevation of the skin,
less than 0.5 cm, that
contains serous fluid.

Patch - A
circumscribed area
of discoloration,
greater than 1 cm,
which is neither
elevated or
depressed relative
to the surrounding
skin.

Bulla (pl. Bullae)A raised,

circumscribed lesion
greater than 0.5 cm
that contains serous
fluid.

Wheal - Transient,
circumscribed,
Nodule - A palpable,
Tumor - Solid, firm
elevated papules or
solid lesion, greater than lesions typically > 2
1 cm in diameter. These cm that can be above, plaques, often with
are usually found in the
level with, or beneath erythematous
dermal or subcutaneous the skin surface. Also borders and pale
centers.
tissue, and the lesion
known as a mass.
may be above, level with,
or below the skin
surface.

Pustule - A small (< 1

cm in diameter),
circumscribed superficial
elevation of the skin that
is filled with purulent
material. Can also be
described as a vesicle
filled with pus.
Secondary Lesion - Modification of a primary lesion that results from traumatic injury, evolution
from the primary lesion, or other external factors. Secondary lesions
include scale, crust, erosion,fissure, ulceration, excoriation, or lichenification.

Scale - Visible
fragments of the
stratum corneum as it Crust - Varying colors
is shed from the skin. of liquid debris (serum
or pus) that has dried
on the surface of the
skin.

Fissure - Sharplydefined, linear or

wedge-shaped tears in
Ulceration - A
the epidermis with
localized defect in the
abrupt walls.
skin of irregular size
and shape where
epidermis and some
dermis have been lost.

Lichenification Diffuse thickening of

the epidermis, with
resulting accentuation
of skin lines.

Erosion - Loss of
superficial layers of
upper epidermis by
wearing away as from
friction or pressure.

Excoriation - Skin
abrasions, usually
superficial, due to
scratching of the skin.