Which secondary skin lesion is a visible opening on the surface of the skin that may result in the loss of portions of the dermis?

• A. Crust
• B. Ulcer
• C. Fissure
• D. Excoriation

Answer: (B)

The main idea here is understanding what a secondary skin lesion that forms an actual opening with tissue loss looks like. An ulcer is a deeper break in the skin that creates a visible opening or sore on the surface and can extend into the dermis, sometimes even deeper. This tissue loss is what sets ulcers apart from other secondary lesions. A crust is just dried fluids on the surface, not an opening. A fissure is a crack or split in the skin, often linear, which may not involve actual tissue loss to create an open wound. An excoriation is a superficial scratch or abrasion. So the description—an opening on the surface that may involve loss of portions of the dermis—fits an ulcer best.