Exam Summary


1. Introduction

  • Introduce yourself and the exam
  • Ask the patient if they have any area of skin they are concerned about
  • Hand Hygeine

2. General Inspection

  • Colour of skin - look for hyperpigmentation, tan, jaundice, pallor
  • Obvious lesions

For each of the following areas of skin look for:
  • Erythema - vasodilation causing skin redness
  • Telangiectasis - Visible permanent dilated blood vessels
  • Macules - An area of skin (variable size) which has altered skin colour but is not palpable and has normal skin texture
  • Papules - An area of skin that is elevated and <1cm diameter.
  • Nodules - An area of skin that is elevated and >1cm diameter.
  • Plaques and Scales - A palpable area of skin >1cm diameter which involves excess keratin. May be elevated or depressed.
  • Wheals - A temporary swelling of the skin
  • Vesicles and Bullae - A fluid filled lesion. Vesicles are <0.5cm, Bullae are >0.5cm on diameter.
  • Pustules - A vesicle or bulla containing pus.
  • Erosions - A superficial loss of epidermis that heals without scaring
  • Ulcers - An area of tissue loss that varies in depth
  • Excoriation - An area of skin which has lost its epidermis due to scrathcing
  • Scabs - Dried exudate from an erosion or ulcer
  • Vitiligo - An area of hypopigmentation
  • Skin Thinning (Atrophy)
  • Skin Hardening (Sclerosis)
palmar_erythema.jpg
Erythema

Telangiectasis.jpg
Telangiectasis
Cafe au lait.jpg
A birthmark - a type of macule
Basal Cell Carcinoma.jpg
Basal Cell Carcinoma Nodule

Papule - Dermatomyositis.jpg
Papules in Dermatomyositis
Psoriasis.JPG
Plaque in Psoriasis
Wheal.JPG
Wheal

Chickenpox.JPG
Vesicles in Chicken Pox
Bulla.jpg
Bulla
Pustule.jpg
Pustule
Erosion.jpg
Skin erosion
Diabetic_Wound_121.jpg
Diabetic Ulcer
Scleroderma.jpg
Sclerotic skin in Scleroderma
Atrophied skin.png
Atrophied Skin
Vitiligo.JPG
Vitiligo
Scab.jpg
Scab
Excoriation.JPG
Excoriation in Excoriation Disorder


Look especially for
  • Melanoma
  • Squamous Cell Carcinoma
  • Basal Cell Carcinoma
  • (see skin cancer)

Melanoma.jpg
Melanoma
Squamous Cell Carcinoma.jpg
Squamous Cell Carcinoma
Basal Cell Carcinoma.jpg
Basal Cell Carcinoma


3. Face

a. Scalp

  • Also part hair to look at the skin

b. Ears

  • Look behind the ear
  • Look at the ear and the external canal

c. Eyes

  • Look at the sclerae and conjunctiva

d. Nose

  • Look at the nasal mucosa

d. Mouth

  • Look at the mucosa, tongue, palate and teeth

4. Neck

a. General

  • Look for lesions

b. Cervical Lymph Nodes

  • Palpate from behind the patient

5. Hand and Nails

  • Look at the fingers, palms and interdigital spaces
  • Look at the fingernails noting:
    • Colour
    • Surface appearance
    • Nail fold area

6. Arm

a. General

  • Look for lesions

b. Axillary Lymph Nodes

  • Behind anterior axillary fold
  • In front of posterior axillary fold
  • Corresponding positions on the upper part of the arm
  • Move the patient's arm down to the side and feel deep into the top of the axilla.

7. Chest and Breasts

  • Ask for consent to examine the patient's breasts. (also see Breast Examination - if indicated)

8. Abdomen

  • Examine the skin of the abdomen with the patient's hands by their side.

9. Legs

a. General

  • Feel and look at the patient's legs
  • Look at the feet - dorsum, soles, interdigital spaces and toenails

b. Inguinal Lymph Nodes

  • Palpate the inguinal nodes

10. Liver and Spleen

  • Palpate noting size and texture

11. Back

  • Ask the patient to turn over or stand up to examine their back
  • With permission examine the buttocks
  • Continue to examine the posterior side of the legs, palpating as you go.

12. Conclude

Thank the patient and offer assistance

See Also

Skin Cancer
Breast Cancer

References

Principles of Clinical Practice - Clinical Examinations Guide 2015
Palmar erythema photo: https://thebileflow.wordpress.com/2012/03/22/pathology-palmar-erythema/
Telangiectasis photo: "Case 115" by Herbert L. Fred, MD and Hendrik A. van Dijk - Images of Memorable Cases: Cases 115 & 116, http://cnx.org/content/m15016/1.3/. Licensed under Attribution via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Case_115.jpg#/media/File:Case_115.jpg
Macule image: "CALSpot" by T Gnaevus Faber - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:CALSpot.jpg#/media/File:CALSpot.jpg
Papule image:
"Dermatomyositis2" by Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, Lisa G. Rider - http://dermatology.cdlib.org/1502/reviews/photoessay/2.jpg. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Dermatomyositis2.jpg#/media/File:Dermatomyositis2.jpg
Skin Plaque image: By MediaJet (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Wheal image: "Hives2010" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Hives2010.JPG#/media/File:Hives2010.JPG
Vesicle image: By Øyvind Holmstad (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons
Bulla image: "Smlp6860" by Frazzmatazz - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Smlp6860.jpg#/media/File:Smlp6860.jpg
Pustule image: By Saurabh R. Patil (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
Erosion image: http://intranet.tdmu.edu.ua/data/kafedra/internal/infect_desease/classes_stud/en/med/lik/ptn/Dermatovenereology/4/01.%20Anatomy,%20histology%20of%20the%20skin.%20Skin%20lesions.%20Scabies.%20Pediculosis.Demodecosis..htm
Venous Ulcer photo:
"Úlceras antes da cirurgia" by Nini00 - Own work --> http://www.varizinforma.com/Photo.htm (.jpg). Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:%C3%9Alceras_antes_da_cirurgia.JPG#/media/File:%C3%9Alceras_antes_da_cirurgia.JPG
Diabetic Ulcer Image:
By Intermedichbo at sr.wikipedia [CC BY-SA 3.0 rs (http://creativecommons.org/licenses/by-sa/3.0/rs/deed.en) or GFDL (http://www.gnu.org/copyleft/fdl.html)], from Wikimedia Commons
Excoriation image: "Derma me" by Friend: professional photographer - I was photoed in with a digital camera. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Derma_me.JPG#/media/File:Derma_me.JPG
Scab image: "Scab" by ALEF7 - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Scab.jpg#/media/File:Scab.jpg
Vitiligo: "Vitiligo2" by James Heilman, MD - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Vitiligo2.JPG#/media/File:Vitiligo2.JPG
Skin Atrophy image: By sansea2 (Myself. It is a picture of my lower right arm.) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0) or GFDL (http://www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons
Skin Sclerosis image: "Left Arm Scleroderma Patient" by AVM (talk) 02:54, 9 January 2009 (UTC) - Own work. Licensed under CC BY 3.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Left_Arm_Scleroderma_Patient.jpg#/media/File:Left_Arm_Scleroderma_Patient.jpg
Melanoma image: "Melanoma" by Unknown - National Cancer Institute (AV Number: AV-8500-3850; Date Created: 1985; Date Entered: 1/1/2001), http://visualsonline.cancer.gov/details.cfm?imageid=2184. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Melanoma.jpg#/media/File:Melanoma.jpg
Basal Cell Carcinoma image: "BCC Nodular type" by M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara - M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara: Cutaneous lesions of the nose. In: Head & face medicine Band 6, 2010, S. 7, ISSN 1746-160X. doi:10.1186/1746-160X-6-7. PMID 20525327. (Review). Open Access. Licensed under CC BY 2.0 via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:BCC_Nodular_type.jpg#/media/File:BCC_Nodular_type.jpg
Squamous Cell Carcinoma image: "Squamous Cell Carcinoma" by Unknown photographer/artist - http://visualsonline.cancer.gov/details.cfm?imageid=2165. Licensed under Public Domain via Wikimedia Commons - https://commons.wikimedia.org/wiki/File:Squamous_Cell_Carcinoma.jpg#/media/File:Squamous_Cell_Carcinoma.jpg