Ulcerative lesions

Definitions

Primary and secondary skin lesions

1. Macule

  • Focal area of colour change
  • No elevation or depression in relation to surroundings

2. Papule

  • Solid raised lesion
  • Less than 5mm in diameter

3. Nodule

  • Solid raised lesion
  • More than 5mm in diameter

4. Sessile

  • Tumor/growth
  • Base is widest part of lesion

5. Pedunculated

  • Tumor/growth
  • Base is narrower than widest part of lesion

6. Papillary

  • Tumor/growth
  • Numerous warty projections

7. Verrucous

  • Tumor/growth
  • Rough warty surface

8. Vesicle

  • Superficial blister filled with clear fluid
  • Less than 5mm in diameter

9. Bulla – Blister > 5mm in diameter

10. Pustule – Blister filled with purulent exudate

11. Ulcer

  • Loss of surface epithelium ± underlying CT
  • Depressed/ excavated

12. Erosion

  • Superficial lesion
  • Partial/ total loss of surface epithelium
  • After rupture of vesicle or bulla

13. Fissure – Narrow slit like ulceration/ groove

14. Plaque – Elevated and flat on surface

15. Petechia – Round pinpoint area of hemorrhage

16. Ecchymosis – Non elevated hemorrhage, larger than petechia

17. Telangiectasia

  • Vascular lesion
  • Dilation of small superficial blood vessel

18. Cysts

  • Pathological epithelium lined cavity
  • Filled with liquid or semisolid content

19. Unilocular – Radiolucent lesion – single compartment

20. Multilocular – Radiolucent lesion – several compartments


Traumatic lesions

Clinical manifestations of trauma

  1. Acute/chronic ulcers
  2. Red/white lesions
  3. Mucositis
  4. Reactive hyperplasia
  5. Bone exposure and sequestration

Etiology

Physical trauma

  • Factitial injury – Self induced/psychological
    • Eg. Cheek biting – subconscious reaction to stress, emotions, boredom
  • Riga-Fede disease – Traumatic ulcer on anterior tongue with natal teeth in infants, or repetitive tongue thrusting habit after eruption of 1ry lower incisors
  • Frictional hyperkeratosis – white lesion, ill fitting dentures
  • Iatrogenic

Chemical burns, thermal burns

Therapeutic radiation

Classification

1. Acute traumatic ulcer

  • Pain
  • Yellow base, red halo
  • Heals in 7 to 10 days

2. Chronic traumatic lesions

  • Little or no pain
  • Scar formation
  • Mimic carcinoma/infective ulcer

Clinical

  • Single lesion
  • Erythematous
  • Non inverted margins
  • Clean base covered in pseudomembrane
  • Painful
  • Disappear in 7-10 days after eliminating cause

Histology

  • Loss of epithelium – replaced by fibrin network
  • Granulation tissue base
  • Scar formation deep in tissues
  • Dense inflammatory infiltrate – macrophages and eosinophils

Management

  • Observe for 2 weeks to rule out infection
  • Topical corticosteroids

Pathological lesions

Etiology

1. Neoplasm

2. Immunological disease

3. Aphthous ulcer/ Canker sore – Multifactorial

4. Infections

Nb: Chronic infectious ulcers (TB, syphilis, fungal)

  • Mimic carcinoma/traumatic ulcer
  • Non healing and persistent
  • Multiple
  • Diagnosis – Biopsy and culture
  • Management – Antimicrobial agent