SU18.1-3 | Skin and Subcutaneous Tissue — Glossary

A clinical checklist for a suspicious pigmented lesion — Asymmetry, Border irregularity, Colour variation, Diameter >6 mm, Evolution.

A localised, walled-off collection of pus that cannot resolve without drainage.

A rough, scaly premalignant patch on sun-damaged skin that may progress to squamous cell carcinoma.

The tissue layer a swelling occupies (skin, subcutaneous, fascial, muscular or deeper); identifying it is the first step in diagnosis.

A malignant tumour of basal keratinocytes; the rodent ulcer with a rolled pearly edge, locally invasive but rarely metastasising.

A well-differentiated, slow-growing neoplasm that does not invade or metastasise.

Squamous cell carcinoma in situ — intraepidermal malignant change not yet invading the basement membrane.

The vertical depth of a melanoma in millimetres — the single most important prognostic factor and the determinant of definitive excision margin.

A coalescent staphylococcal infection of several adjacent hair follicles forming an indurated slough-filled mass with multiple openings; strongly associated with diabetes.

A spreading, non-suppurative infection of the dermis and subcutaneous tissue with an ill-defined edge, usually caused by Streptococcus pyogenes.

The feel of a swelling on palpation — soft, cystic, firm, hard or bony-hard — helping suggest its nature.

An expansile impulse felt over a swelling on coughing, characteristic of a hernia at a hernial orifice.

A crackling sensation on palpation due to gas in the soft tissues, a warning sign of necrotizing or gas-forming infection.

Surgical removal of dead and infected tissue, the definitive treatment of necrotizing fasciitis.

A small, firm benign dermal nodule that characteristically dimples when pinched.

The border of a swelling, described as well-defined or diffuse, helping distinguish benign from infiltrative lesions.

A superficial, sharply demarcated, raised streptococcal infection of the upper dermis with lymphatic involvement.

A pulsation that pushes the examining fingers apart in all directions, indicating an aneurysm — such a swelling must never be incised.

Sampling of cells from a solid swelling or node with a fine needle to detect malignant or infective change.

The degree to which a swelling is tethered to the overlying skin or underlying deep structures; fixity suggests malignancy.

The clinical sign of a fluid (pus) collection within a swelling, indicating the need for incision and drainage.

The sign that a swelling contains fluid, elicited by pressure transmitted equally in two planes at right angles.

A wave transmitted across a large fluid-filled swelling when one side is tapped, confirming fluid content.

Inflammation/infection of hair follicles producing small superficial pustules, usually staphylococcal.

Necrotizing fasciitis of the perineum and scrotum, a urological surgical emergency.

A boil — staphylococcal infection of a single hair follicle and surrounding tissue that points and discharges pus.

The surgical opening of an abscess to release pus, break down loculi and allow healing by secondary intention.

The first stage of examining a swelling — recording site, size, shape, surface, overlying skin, number and visible movement.

A benign tumour of mature fat, presenting as a soft, lobulated, mobile subcutaneous swelling with a positive slip sign.

Inflammation of lymphatic channels seen as red streaks tracking from an infection towards the regional lymph nodes.

A malignant tumour of melanocytes; the most aggressive skin cancer, spreading by lymphatics and bloodstream.

A neoplasm that invades locally and is capable of metastasising to distant sites.

A squamous cell carcinoma arising in a long-standing chronic wound, sinus or old burn scar.

A benign collection of melanocytes (a mole); change in one is the warning sign of melanoma.

A rapidly spreading, life-threatening necrosis of subcutaneous tissue and deep fascia, often polymicrobial or group A streptococcal, requiring emergency debridement.

The systematic feeling of a swelling for temperature, tenderness, size, shape, surface, edge, consistency and the special signs.

The breach in the skin (cut, bite, ulcer, injection site) through which organisms gain access to cause soft-tissue infection.

A lesion carrying a recognised risk of progressing to cancer, e.g. actinic keratosis and Bowen's disease.

The ability of a swelling (e.g. a hernia) to be returned into the cavity from which it arose.

The nodes draining the area of a swelling, examined in every case because their state may reveal malignant or infective spread.

The classic clinical appearance of a basal cell carcinoma — a slowly enlarging ulcer with a raised, rolled, pearly edge and telangiectasia.

A benign skin-tethered cyst, often with a central punctum, treated by complete excision including its wall.

Biopsy of the first lymph node draining a tumour (used in intermediate/thick melanoma) to stage the regional nodes.

The way a lipoma slips away from the edge of a palpating finger, helping identify it as a benign fatty swelling.

A malignant tumour of squamous keratinocytes that can metastasise to regional lymph nodes.

The formation of pus — an accumulation of dead neutrophils, bacteria and liquefied tissue.

Any abnormal localised enlargement; examined systematically to determine its plane, tissue of origin and likely pathology.

The transmission of light through a swelling in a darkened room, indicating clear fluid (e.g. cystic hygroma, hydrocele, ganglion).

A pulsation that merely lifts a swelling lying over an artery, distinct from the expansile pulsation of an aneurysm.

The surgical maxim 'where there is pus, let it out' — the cornerstone of abscess management.

Complete excision of a malignancy with a margin of surrounding normal tissue, the margin widening with tumour aggressiveness.