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51 Approach to the Patient With a Skin Disorder
Thomas J. Lawley / Kim B. Yancey

	Figure 51-1  Superficial spreading melanoma. This is the most common type of melanoma. Such lesions usually demonstrate asymmetry, border irregularity, color variegation (black, blue, brown, pink, and white), a diameter >6 mm, and a history of change (e.g., an increase in size or development of associated symptoms such as pruritus or...
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	Figure 51-2  Nevomelanocytic nevus. Nevi are benign proliferations of nevomelanocytes characterized by regularly shaped hyperpigmented macules or papules of a uniform color.
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	Figure 51-3  A schematic representation of several common primary skin lesions (see Table 51-1).
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	Figure 51-4  Necrotizing vasculitis. Palpable purpuric papules on the lower legs are seen in this patient with cutaneous small vessel vasculitis. (Courtesy of Robert Swerlick, MD; with permission.)
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	Figure 51-5  Meningococcemia. An example of fulminant meningococcemia with extensive angular purpuric patches. (Courtesy of Stephen E. Gellis, MD; with permission.)
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	Figure 51-6  A–D. The distribution of some common dermatologic diseases and lesions.
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	Figure 51-7  Psoriasis. This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale.
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	Figure 51-8  Dermatitis herpetiformis. This disorder typically displays pruritic, grouped papulovesicles on elbows, knees, buttocks, and posterior scalp. Vesicles are often excoriated due to associated pruritus.
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	Figure 51-9  Erythema multiforme. This eruption is characterized by multiple erythematous plaques with a target or iris morphology. It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV). (Courtesy of the Yale Resident's Slide Collection; with...
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	Figure 51-10  Allergic contact dermatitis (ACD). A. An example of ACD in its acute phase, with sharply demarcated, weeping, eczematous plaques in a perioral distribution. B. ACD in...
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	Figure 51-11  Urticaria. Discrete and confluent, edematous, erythematous papules and plaques are characteristic of this whealing eruption.
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	Figure 51-12  Vitiligo. Characteristic lesions display an acral distribution and striking depigmentation as a result of loss of melanocytes.
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