How do I perform a methodical skin check?

How to Perform a Methodical Skin Check

A methodical skin check should include a systematic examination of the entire body surface using the ABCDE criteria (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution) and the "ugly duckling" sign to identify suspicious lesions that differ from other moles on the patient.

Preparation and Equipment

• Ensure proper lighting with bright, preferably natural light to accurately assess skin lesions 1
• Use a suitable examination table that allows the patient to be positioned properly for full skin access 1
• Consider having a dermatoscope available for closer examination of suspicious lesions 2
• Ensure patient privacy and comfort by explaining the procedure and providing appropriate gowning 1

Systematic Examination Approach

Step 1: Exposed Areas

• Begin with the face, including ears, scalp (parting hair in sections), and neck 1, 3
• Examine the hands, including palms, between fingers, and nails 3
• Check arms and forearms, including the antecubital fossae 3

Step 2: Trunk Examination

• Examine the chest, abdomen, and back systematically 3
• Pay special attention to areas with limited sun exposure (e.g., between shoulder blades) 1
• For women, examine under breasts and in the inframammary fold 4

Step 3: Lower Extremities

• Examine thighs, legs, feet including soles, between toes, and toenails 3
• Check the gluteal region and perianal area 3

Step 4: Genital Examination

• Include genital areas in the examination when appropriate and with proper consent 3

Assessment Criteria

ABCDE Rule for Melanoma Detection

• Asymmetry: Look for moles with irregular shapes or halves that don't match 2
• Border irregularity: Identify lesions with jagged, notched, or blurred edges 2
• Color variation: Note moles with multiple colors or uneven distribution of color 2
• Diameter: Pay attention to lesions larger than 6mm (pencil eraser size) 2
• Evolution: Document changes in size, shape, color, or symptoms over time 2

Additional Assessment Techniques

• Apply the "ugly duckling" sign - identify moles that look different from surrounding moles 2
• Consider using Wood's light for hypopigmented or hyperpigmented lesions 1
• Document findings with photography for monitoring changes over time 1

Documentation

• Record the location, size, color, and morphology of suspicious lesions 3
• Consider using a body map diagram to mark locations of concerning lesions 3
• Document any changes from previous examinations 3

Follow-up Actions

• Biopsy suspicious lesions either partially or completely based on clinical judgment 1
• For concerning lesions, perform either shave, punch, or excisional biopsy as appropriate 5
• Educate patients about sun protection, self-examination techniques, and warning signs 1

Common Pitfalls and Considerations

• Don't miss hidden areas such as the scalp, between toes, behind ears, and genital regions 3
• Be aware that melanomas can occur in non-sun-exposed areas, particularly in people with darker skin 2
• Remember that complete skin examination leads to detection of skin cancers that would otherwise be missed (3.3% of patients had basal cell carcinomas and 0.6% had melanomas discovered only through complete examination) 3
• Recognize that persons with darker skin color are often diagnosed at later stages when skin cancer is more difficult to treat 2

Patient Education

• Teach patients the ABCDE criteria and how to perform regular self-examinations 1
• Emphasize the importance of reporting any new or changing skin lesions 4
• Discuss sun protection strategies including sunscreen, protective clothing, and sun avoidance 1