HISTORY AND EXAMINATION

Dr Emma McMullen

Patient 1

72 year old female Lesion on right shin

What do we need to know?

History

6/12, unsure if preceding lesion Enlarging/changing shape and colour Asymptomatic No previous history of skin cancer Lived in West Africa until the age of 19 Tans but burns easily Skin phototype 2 No relevant family history On warfarin for AF

HISTORY - LESIONS

How long has it been there? When did you first notice it? Has it changed? Has it got bigger in diameter? Has it changed shape/contour? Has it changed colour? Any symptoms itch/bleeding/crusting? History of sun exposure/skin type.

SKIN EXAMINATION

Introduction Consent Chaperone Exposure

EXAMINATION

How are you going to examine this patient?

Look Palpate Describe Examine relevant hidden areas Develop a system e.g. top to toe

Examination

Site Size Morphology Colour Rest of skin? Other relevant general examination? Dermoscopy

Dermoscopy

Patient 2

43 year old man, rash to trunk and limbs

What do we need to know?

HISTORY

6 weeks of rash Extremely pruritic Ankles, wrists, lower back Otherwise well No family history of relevance No relevant drug history

HISTORY

When did it start? Where did it first appear/pattern of progression? Symptoms? PMHx Drug History - Topical / oral meds/ OTC preparations? Occupational/recreational hx Travel FHx/ contacts Patients thoughts/concerns

EXAMINATION

Describe these lesions

Purple Polygonal Papules and plaques

EXAMINATION

Buccal mucosa

Wickhams striae

Remember hidden sites!

DOCUMENTATION

A person reading what you have written should be able to picture the problem accurately in their mind! Accurate description with correct terminology.

DESCRIPTION OF LESIONS

Macule Papule Vesicle/bulla Nodule Plaque Patch

DISTRIBUTION OF A RASH

Flexural (eczema) Extensor surfaces (psoriasis) Photo exposed sites Hands and feet Nails Hair Mucosal surfaces

ADDITIONAL FEATURES

Colour e.g. pigmented, erythematous etc. Configuration e.g. annualar, target-like Morphology e.g. firm, hot, mobile Secondary changes e.g. excoriations, crusting, scale

LEARNING POINTS

Consideration for patient Be hands on with examination approach Correct terminology