Realistically, the skin exam is occurring in tandem with other components of the physical exam (when you examine the abdomen for instance, you should also assess any dermatological skin findings. That being said this page focus on the the exam in isolation, and will also one suggested order of completing a full dermatological skin exam.
DESCRIBING THE FINDING
Objectively describing a dermatological finding is vital to communicating with other physicians about it. Avoid describing the lesions in terms of a possible diagnosis (i.e. shingles outbreak) and instead describe what is observed in a factual manner. When doing this focus on the following details:
- Feel: is the skin finding flat (macule) or raised (papule). The ultimate test of this is if you can feel the finding with your eyes closed, it is a papule!
- Color: is the area red? Inflamed? Micaceous?
- Arrangement: is the distribution linear? Random?
- Location on the body: while a subtle point, certain dermatological findings have specific locations they are found.
SEQUENCE OF THE SKIN EXAM
The below sequence is one suggestion to conduct a complete skin exam. Wash your hands before beginning and use gloves (especially for most areas and open/crusted lesions):
Head: have the patient remove their glasses (if they have them) for this portion of the exam. Pay special attention to
- Oral mucosa
- Scalp (can part hair with a cotton swab)
- Neck and lymph nodes
Arms: given their accessibility, next you can move onto he arms.
Back: move onto the back of the patient opening up the hospital gown as needed
- Back of scalp and neck
- Behind the ears
Front: Transition to the front of the patent looking at:
- Genital area (including buttocks)
- Inguinal lymph nodes
Legs: finish the exam by assessing the lower extremities of the patient:
- Behind the knee
- Soles of the feet
- Between the toes
“DO NOT MISS” AREAS
There are certain regions of the body that one should almost always look at. These include:
- Mucous membranes
Furthermore, there are the following “hidden areas” that are frequently overlooked.
- Outer ear
- Behind the ear
- Inner portion of the eye (medial canthi)
- Folds around nostrils
- Intergluteal cleft and perianal skin
- In between toes
Page Updated: 01.23.2016