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eFigure 37–17. Gross pathology showing intestinal ulcers due to amebiasis. (From Dr. Mae Melvin, Public Health Image Library, CDC.) A photo of a gross pathology showing intestinal ulcers due to amebiasis. The tissue is red and covered in lesions.

Current Medical Diagnosis & Treatment 2024 > Amebiasis

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eFigure 37–40. Worm blister caused by the head of a female Guinea worm (Dracunculus medinensis). A: The female Guinea worm induces a painful blister. B: After rupture of the blister, the worm emerges as a whitish filament in the center of a painful ulcer, which is often secondarily infected. (Reproduced with permission from Global 2000/The Carter Center, Atlanta, Georgia.) 2 photos of a worm blister. Photo A depicts a blister on the foot. Photo B shows the Guinea worm emerging as a whitish filament in the center of the ulcer.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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eFigure 37–40. Worm blister caused by the head of a female Guinea worm (Dracunculus medinensis). A: The female Guinea worm induces a painful blister. B: After rupture of the blister, the worm emerges as a whitish filament in the center of a painful ulcer, which is often secondarily infected. (Reproduced with permission from Global 2000/The Carter Center, Atlanta, Georgia.) 2 photos of a worm blister. Photo A depicts a blister on the foot. Photo B shows the Guinea worm emerging as a whitish filament in the center of the ulcer.

Current Medical Diagnosis & Treatment 2024 > Dracunculiasis

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Figure 8–7. Squamous cell carcinoma of the palate. (Used, with permission, from Frank Miller, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo of squamous cell carcinoma of the palate; with raised, firm, white lesions with ulcers at the base.

Current Medical Diagnosis & Treatment 2024 > Leukoplakia, Erythroplakia, Lichen Planus, & Oropharyngeal Cancer

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eFigure 33–2A. Recurrent oral aphthous stomatitis. A 58-year-old man presented with a 1-year history of recurrent painful sores in his mouth. He had lost 20 pounds over the year because it hurt so much to eat. The ulcers, which had a red base and were covered with a central white membrane, occurred in different locations—on his tongue, gums, inner lips, and buccal mucosa (shown here). HIV-AIDS is an underlying systemic disease that can be documented on work-up of such patients. (Used, with permission, from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo of a pale, flat, glossy ulcer in the buccal mucosa. The margins are well-defined and reddish.

Current Medical Diagnosis & Treatment 2024 > HIV Infection & AIDS: Complications

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eFigure 33–2B. Two aphthous ulcers on the tongue. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr., Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo of two pale, flat, slightly elongated ulcers on the tip of tongue.

Current Medical Diagnosis & Treatment 2024 > HIV Infection & AIDS: Complications

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eFigure 33–2C. Minor aphthous ulcer occurring on the buccal mucosa. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr., Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo of a pale, flat, spherical ulcer in the inside of lower lip. The ulcer has a slight depression at its center.

Current Medical Diagnosis & Treatment 2024 > HIV Infection & AIDS: Complications

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Figure 36–1. Primary syphilis with a large chancre on the glans of the penis. The multiple small surrounding ulcers are part of the syphilis and not a second disease. (Used, with permission, from Richard P. Usatine, MD in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo shows that the tip of the penis is inflamed, with ulcers on the inflamed region.

Current Medical Diagnosis & Treatment 2024 > Clinical Stages of Syphilis

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eFigure 36–1. Primary syphilis with a chancre over the lip of a woman. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 3rd ed. McGraw-Hill, 2019). A patient with primary syphilis exhibits a large round eroded ulcer with a thick raised peripheral zone, above the vermilion border of upper lip.

Current Medical Diagnosis & Treatment 2024 > Clinical Stages of Syphilis

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eFigure 36–5. Neuropathic arthropathy (Charcot joint) from tertiary syphilis. (From Susan Lindsley, Public Health Image Library, CDC.) A photo shows an enlarged and swollen leg with large patches of discoloration and ulcers.

Current Medical Diagnosis & Treatment 2024 > Clinical Stages of Syphilis

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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eFigure 6–10. A: Ulcer on the nasal tip is the most obvious warning sign for this infiltrative BCC. B: Nodular BCC on the nasal ala of an 82-year-old woman. The nose is a very common location for a basal cell carcinoma. C: Large ulcerated nodular BCC on the mid-chest of a homeless man. The authors excised this in a free clinic located in a church basement. D: Large nodular basal cell carcinoma with an annular appearance on the face of a homeless woman. E: Superficial basal cell carcinoma on the back of a 45-year-old man who enjoys running in the California sun without his shirt. Note the diffuse scaling, thready border (slightly raised and pearly), and spotty hyperpigmentation on the edges. F: Large superficial BCC located on the back. Note the thready pearly border and small areas of pigmentation—both common features in superficial BCCs. G: Sclerosing BCC on the nose. Note the ivory white tumor that extends beyond the pearly pink segment. This took 4 stages of Mohs surgery to remove. H: Sclerosing and infiltrative basal cell carcinoma in a 45-year-old man diagnosed with a shave biopsy. The patient was sent for Mohs surgery because the BCC was aggressive and encroaching on the lower eyelid. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) Eight photos show ulcers and basal cell carcinomas on the face.

Current Medical Diagnosis & Treatment 2024 > Basal Cell Carcinoma

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Figure 6–12. Orolabial herpes simplex showing deroofed blisters (ulcer). (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 2nd ed. McGraw-Hill, 2013.) A photo of a pink and white blister on a patient's upper lip.

Current Medical Diagnosis & Treatment 2024 > Herpes Simplex (Cold or Fever Sore; Genital Herpes)

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Figure 6–37. Ulcer—venous stasis ulcer. (Reproduced with permission from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley H. The Color Atlas of Family Medicine, 3rd ed. McGraw-Hill, 2019.) A photo of a severe ulceration in the lower leg, close to the medial malleolus. It appears as a large, bloody red patch of exposed skin with serous fluid oozing from the ulcer.

Current Medical Diagnosis & Treatment 2024 > Venous Stasis Ulcers

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eFigure 22–30. Behçet syndrome characterized by recurrent oral and genital ulcers in a 17-year-old girl. (Used, with permission, from Richard P. Usatine, MD, in Usatine RP, Smith MA, Mayeaux EJ Jr, Chumley HS. The Color Atlas and Synopsis of Family Medicine, 3rd ed. McGraw-Hill, 2019.) A patient with Behcet disease exhibits white ulcers in the inner side of lower lip and inflammation of gums.

Current Medical Diagnosis & Treatment 2024 > Behçet Disease

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eFigure 17–7. Distal esophagus with ulceration involving less than 75% of circumference (LA Grade C). (Used, with permission, from A. Huang.) An endoscopy image of the esophagus reveals irregular, bright red ulcerated lesions spread across 50 to 60 percent of the mucosal circumference.

Current Medical Diagnosis & Treatment 2024 > Gastroesophageal Reflux Disease

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eFigure 17–8. Distal esophagus with ulceration involving >75% of the esophageal circumference consistent with LA Grade D. (Used, with permission, from A. Huang.) An endoscopy image of the esophagus reveals bright red ulcerated lesions covering 80 to 90 percent of the mucosal circumference.

Current Medical Diagnosis & Treatment 2024 > Gastroesophageal Reflux Disease

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eFigure 17–18. A: A benign, clean-based gastric ulcer. B: A large deep gastric ulcer due to NSAID ingestion with red spots suggestive of recent bleeding. Biopsy of ulcer margins were negative for carcinoma. (Used, with permission, from Y. Chen.) An endoscopy image reveals an ulcerated lesion on the gastric mucosa. It appears pitted and pale pink, with a bright red border. An endoscopy image reveals a large, irregular gastric ulcer. The ulcer is white with bright red spots.

Current Medical Diagnosis & Treatment 2024 > Peptic Ulcer Disease

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eFigure 17–18. A: A benign, clean-based gastric ulcer. B: A large deep gastric ulcer due to NSAID ingestion with red spots suggestive of recent bleeding. Biopsy of ulcer margins were negative for carcinoma. (Used, with permission, from Y. Chen.) An endoscopy image reveals an ulcerated lesion on the gastric mucosa. It appears pitted and pale pink, with a bright red border. An endoscopy image reveals a large, irregular gastric ulcer. The ulcer is white with bright red spots.

Current Medical Diagnosis & Treatment 2024 > Peptic Ulcer Disease

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eFigure 17–19. Clean based duodenal white 1-cm ulcer of duodenal bulb. (Used, with permission, from Y. Chen.) An endoscopy image reveals a duodenal ulcer as a white, pitted lesion on the mucosal surface.

Current Medical Diagnosis & Treatment 2024 > Peptic Ulcer Disease

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eFigure 17–20. A large, deep duodenal ulcer is seen with brown spots suggesting recent bleeding. There is visible vessel present. (Used, with permission, from Richard W. Mclean I, MD.) An endoscopy image reveals a large duodenal ulcer. The ulcer is white with small irregular brown patches, indicative of bleeding.

Current Medical Diagnosis & Treatment 2024 > Peptic Ulcer Disease

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eFigure 17–25. Crohn disease of colon characterized by scattered ulcers with adherent mucopus and intervening normal appearing mucosa. (Used, with permission, from A. Huang.) An endoscopy image of the colon reveals glossy yellow and white streaks on the mucosa.

Current Medical Diagnosis & Treatment 2024 > Inflammatory Bowel Disease

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eFigure 17–26. Crohn involvement of terminal ileum with extensive linear and stellate ulcers. (Used, with permission, from A. Huang.) An endoscopy image of the colon reveals several white and yellow raised patches scattered over the mucosa.

Current Medical Diagnosis & Treatment 2024 > Inflammatory Bowel Disease

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eFigure 17–27. A Crohn ulcer is seen that has resulted in a colonic stricture. (Used, with permission, from A. Huang.) An endoscopy image of the colon reveals a white, ulcerous lesion at a narrowed stricture. There is slight bleeding from the ulcer.

Current Medical Diagnosis & Treatment 2024 > Inflammatory Bowel Disease

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eFigure 17–29. Severe ulcerative colitis is characterized by granularity, loss of normal vascularity, diffuse erosions and ulcerations, and spontaneous bleeding. (Used, with permission, from Y. Chen.) An endoscopy image of the colon reveals profuse bleeding in the mucosa. The lining appears rough with brown and yellow patches. There is no apparent bleeding.

Current Medical Diagnosis & Treatment 2024 > Inflammatory Bowel Disease

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Figure 29–3. Neuropathic foot ulcer in a patient with diabetes. A patient exhibits a neuropathic foot ulcer on the bottom of the second toe. The ulcer is round, with a thick white border and red center, measuring about 3 centimeters.

Current Medical Diagnosis & Treatment 2024 > Diabetes Mellitus

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eFigure 41–1. An ulcerated mass with submucosal extension is visible in the mid-esophagus amidst columnar epithelium (Barrett esophagus). Biopsies confirmed adenocarcinoma. (Used, with permission, from Yao-Wen Cheng, MD.) An internal view of an esophagus shows a mass on the left side opening representing a mid esophagus adenocarcinoma tumor.

Current Medical Diagnosis & Treatment 2024 > Esophageal Cancer

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eFigure 41–6. A submucosal tumor with central ulceration. Fine-needle aspiration (FNA) confirmed GI stromal tumor (GIST). (Used, with permission, from Yao-Wen Cheng, MD.) A circular mass, a result of a gastrointestinal stromal tumor, G I S T. The center of the mass has a small indentation, caused by fine needle aspiration.

Current Medical Diagnosis & Treatment 2024 > Gastrointestinal Mesenchymal Tumors

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eFigure 14–5. Digital subtraction angiography of the carotid bifurcation showing severe carotid stenosis and a large ulceration. An angiogram image of the heart reveals severe carotid stenosis and a large ulceration.

Current Medical Diagnosis & Treatment 2024 > Occlusive Cerebrovascular Disease

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