From the Guidelines
To document a small area of dry and suspicious skin, first describe the exact location using anatomical landmarks, note the size, appearance, and any specific features, and consider referral for dermatological evaluation or biopsy if the lesion appears concerning for malignancy, as recommended by the most recent guidelines 1. When documenting the lesion, consider the following key points:
- Location: describe the exact location using anatomical landmarks (e.g., "2 cm superior to the left lateral malleolus" or "on the right upper back, 3 cm inferior to the scapula") 1
- Size: note the size of the lesion in centimeters, measuring length, width, and height if elevated
- Appearance: document the appearance including color (e.g., red, hyperpigmented, hypopigmented), texture (e.g., scaly, rough, smooth), borders (e.g., well-defined, irregular, raised), and any specific features like bleeding, crusting, or ulceration
- Symptoms: include whether the area is painful, itchy, or changing over time
- Photography: photograph the lesion if possible, including a ruler for scale, to monitor changes over time and communicate findings to other healthcare providers If the lesion appears concerning for malignancy, consider the "ABCDE" rule, which looks for lesions with asymmetry, border irregularity, nonuniform color, diameter greater than 6 mm, and evolution over time 1. In high-risk populations, a low threshold for performing skin biopsies of suspect lesions is necessary, as skin lesions may be difficult to assess clinically 2, 3. A skin biopsy should include deep reticular dermis if the lesion is suspected to be more than a superficial process, and imaging studies may be performed if extensive disease is suspected 2, 4.
From the FDA Drug Label
Directions for itching of skin irritation, inflammation, and rashes: adults and children 2 years of age and older: apply to affected area not more than 3 to 4 times daily The FDA drug label does not answer the question.
From the Research
Documenting a Small Area of Skin
To document a small area of skin that is dry and suspicious, the following steps can be taken:
- Take a thorough history of the lesion, including its duration, progression, and any associated symptoms 5
- Inspect the whole skin, not just the affected area, to look for any other lesions or abnormalities 6
- Describe the location, distribution, form, and type of lesion in detail, using internationally approved definitions to describe skin changes 6
- Document the findings in writing, including any notable features such as color, size, shape, and texture 6
Characteristics of Suspicious Lesions
When documenting a suspicious lesion, it is important to note any atypical features that may raise clinical suspicion, such as:
- Asymmetry, border irregularity, color variation, or diameter greater than 6mm 7
- Changes in size, shape, or color over time 7
- Bleeding, crusting, or oozing from the lesion 7
Next Steps
If a lesion is deemed suspicious, further investigation may be necessary, such as: