Skin examination Flashcards
Introduction
W - before and after
I - hello my name is An, I’m a 4th year medical student
P - may I confirm your name and DOB
E - I would like to examine your skin. This will involve me looking and feeling your skin lesion, nails, scalp, hair and the inside of your mouth so we can work out what’s happened
R - I will need to expose the area of concern, will this be ok?
Q - Do you have any questions for me?
Q - Are you in any pain?
General inspection
Systemically well/unwell
Site and number of lesions
If multiple, note pattern of distribution
-symmetry
-configuration (discrete, confluent, linear, discoid, annular, target)
Key history details
-timeline of lesion developments - recent changes in size/colour
-pain, itching, tingling, numbness
-discharge, bleeding?
-injuries, trauma
-exacerbating or relieving factors
-irritants, sexual contact?
Inspection of the lesion
Size - measure for accuracy
Colour
Primary morphology - structure of the lesion
-nevus - local tissue malformation
-lesion - altered area of skin
-rash - eruption
-comedone (whitehead or blackhead)
-macule/patch - flat area, altered colour
-papule/nodule - solid raised lesion +-5mm diameter
-plaque - raised scaly lesion 5mm+
-vesicle/bulla - blister +-5mm
-pustule - pus filled U5mm
-abscess - pus filled, within dermis or SC tissue
-weal - raised from dermal edema
-boil - staph infection around hair follicle
-carbuncle - staph infection of multiple follicles
Dermarcation
Secondary morphology
-excoriation
-lichenification - roughened skin, increased skin markings
-scales - flakes of stratum corneum
-crust
-scar
-ulcer - loss of epidermis and dermis
-fissure
-striae
If melanoma - ABCD
Asymmetry - lack of mirror image in all 4 quadrants
Border - irregular
Colour - 2+
Diamter - 6mm+
Feel
Tenderness
Temperature
Surface
-scaling?
-bleeds easily
-signs of infestation - scabies burrows
Consistency
-hard, soft, firm, fluctuant
Blanching or oozing to pressure
Change in sensation
Systemic examination
Nails
Scalp
Hair
Mucous membranes
Systemic examination as indicated by differentials
Further investigations
Swabs
Skin scrapings
Examination under Wood’s light and medical photography
