Features that must be part of the description of a primary lesion are listed in Box 11.1. When a patient has several lesions, their distribution must be specified as well as a possibly notable arrangement. It is essential to identify and describe all lesions present and to record their evolution (dynamism). Thus, for example, in chickenpox, primary lesions manifest as vesicles with a cutaneomucosal distribution and no particular configuration. These lesions evolve towards umbilication and crusting, through several asynchronous flares.

FormalPara Box 11.1

Descriptive Features of a Dermatological Lesion

Nature of the primary lesion

Size of the primary lesion

Disposition, configuration, and demarcations of the primary lesion

Shape and configuration: round, oval, polygonal, target shaped, annular, linear, etc.

Relief: flat, domed, sessile, pediculate, acuminate, umbilication, lobulated, etc.

Demarcations: well defined, not very well defined

Symmetry

Regularity

Color of the lesion and effect of diascopy

Anomalies of the cutaneous surface

Consistence of the lesion

Normal (comparable to healthy skin)

Soft

Firm

Rough

Elastic, renitent (resistant to finger pressure)

Hard

Depressible

Fluctuating

Depth of the lesion

Temperature and sensitivity