Preceptor Education : Module 6 : Teaching the"Family Medicine Clinical Competencies"

Family Medicine Physical Exam Competencies: The Skin Exam

Obtain adequate exposure for appropriate evaluation of skin
Check all skin with particular attention to places not easily seen by patient (scalp, neck, back, back of legs, feet and toes)
View from a distance in order to appreciate general distribution of lesions or skin condition
Be alert to red flags link to red flags (ABCDE of melanoma, non-healing skin lesions in patients with risk for malignancy)

- a circumscribed flat discoloration that may be brown, blue, red, or hypopigmented. E.g. nevus, café-au-lait spot, tinea versicolor
- an elevated solid lesion up to 0.5 cm in diameter. Color can vary. Papules may become confluent and form plaques. E.g. molluscum contagiosum, skin tags, miliaria
- a circumscribed, elevated, superficial, solid lesion more than 0.5 cm in diameter, often formed by the confluence of papules. E.g. eczema, psoriasis
- a circumscribed, elevated, solid lesion more than 0.5 cm in diameter. A large nodule is called a tumor. E.g. rheumatoid nodule, basal cell carcinoma, keratoacanthoma
- a circumscribed, elevated lesion filled with liquid or semi-solid contents, more than 0.5 cm in diameter. E.g. sebaceous cyst, ganglion cyst
- a transient, firm, edematous plaque resulting from infiltration of the dermis with fluid. E.g. hives, dermatographism, angioedema
- a circumscribed superficial fluid-filled blister up to 0.5 cm in diameter. E.g. chicken pox, herpes simples, impetigo
- a circumscribed superficial fluid-filled blister greater than 0.5 cm in diameter; may be formed by a confluence of vesicles. E.g. bullous pemphigoid, contact dermatitis.
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- a circumscribed collection of leukocytes and free fluid that varies in size. E.g. folliculitis, acne. rosacea

- excess dead epidermal cells that are produced by abnormal keratinization and shedding. E.g. psoriasis, seborrheic dermatitis, pityriasis rosea
- a collection of dried serum and cellular debris. E.g. impetigo, tinea capitis
- a focal loss of epidermis and dermis; heal with scarring. E.g. stasis ulcers, pyoderma gangrenosum
- a linear loss of epidermis and dermis with sharply defined, nearly vertical walls. E.g. chapped hands/feet, eczema, perleche
- a depression in the skin resulting form thinning of the epidermis or dermis. E.g. aging, chronic topical steroid use
- an area of thickened epidermis induced by scratching; the skin line are deepened and coarsened. E.g. eczema, neurodermatitis