This video demonstrates the correct technique for conducting a total body skin cancer screening exam, a valuable service to patients. Most patients present to primary care clinics for their dermatologic needs, but others present in the hospital setting or to another specialist. Your ability to recognize common dermatologic conditions and know when to refer those who need further workup and treatment starts with practicing and mastering the performance of a complete skin exam. Some patients at risk for skin cancer may not request a skin exam, so the general dermatological examination is an important opportunity to look for melanomas and other skin cancers, especially in areas patients find hard to see, such as the scalp, oral mucosa, back, posterior legs, and between the toes. Let's begin by reviewing what we are looking for. Skin cancer is an abnormal growth of skin cells. It most often develops on areas of the skin exposed to the sun's rays. Skin cancer affects people of all colors and races, although those with light skin who sunburn easily have a higher risk. Actinic Keratoses These dry scaly patches or spots are precancerous growths. People who get actinic keratoses usually have fair skin. Most people see their first actinic keratoses after 40 years of age because actinic keratoses tend to develop after years of sun exposure. Actinic keratoses usually form on the skin that gets lots of sun exposure, such as the head, neck, hands, and forearms. Because an AK can progress to squamous cell carcinoma, treatment is important. Basal cell carcinomas This is the most common type of skin cancer. Basal cell carcinomas frequently develop in people who have fair skin, yet they can occur in people with darker skin. They develop after years of frequent sun exposure or indoor tanning. Basal cell carcinomas typically look like a flesh-colored, pearl-like bump or a pinkish patch of skin. They may look like a sore that bleeds easily, won't heal, or heals and returns. Basal cell carcinomas are common on the head, neck, and arms, yet can form anywhere on the body, including the chest, abdomen, back, and legs. They can invade the surrounding tissue and grow into the nerves and bones, causing damage and disfigurement. Early diagnosis and treatment of basal cell carcinomas is important. Squamous cell carcinoma Squamous cell carcinoma is the second most common type of skin cancer. People who have light skin are most likely to develop squamous cell carcinoma, yet they can develop in darker-skinned people. Squamous cell carcinoma often looks like a red, firm bump, scaly patch, or a sore that heals and then reopens. They tend to form on skin that gets frequent sun exposure, such as the rim of the ear, face, neck, arms, chest, back, and legs. Squamous cell carcinomas can grow deep in the skin and cause damage and disfigurement. Early diagnosis and treatment can prevent this and stop squamous cell carcinomas from spreading to other areas of the body. Melanoma Melanoma can be a deadly form of skin cancer. Melanoma frequently develops in a mole or suddenly appears as a new dark spot on the skin. Early diagnosis and treatment are crucial. The ABCDEs of melanoma can help you identify melanoma early. A stands for asymmetry. One half is unlike the other half. B stands for border. An irregular, scalloped, or poorly defined border. C stands for color. Is varied from one area to another. Has shades of tan, brown, or black. Or is sometimes white, red, or blue. D stands for diameter. Melanomas are usually greater than 6 millimeters. Melanomas are usually greater than 6 millimeters, the size of a pencil eraser, when diagnosed. But they can be smaller. E stands for evolving. A mole or skin lesion that looks different from the rest or is changing in size, shape, or color. We will now demonstrate the correct technique for a total body skin cancer screening exam. Make sure there is adequate, bright lighting. Have a small ruler or tape measure to document the size of any concerning lesions. Disposable rulers that can be placed on the skin to accompany photographs are ideal. A drape is also useful to allow one to increase patient comfort and limit the area of exposed skin at one time. Consider using latex-free exam gloves while examining body folds like the groin and axilla, wounds, skin infections, or suspected infestations such as scabies. Ask the patient to change into a gown with the opening in the back. Have the patient remove all clothes except for their underwear. Before beginning the examination, cleanse your hands thoroughly. Most physicians choose one of two patient position options for performing the full body skin examination. This will likely vary depending on the patient's age, size, and mobility. Either start with the patient seated and then have them stand for you to look at their back and the back of their legs, or alternatively, have them lie flat with their face up in the supine position, then flip over with their face down in the prone position. Whichever approach you take, plan to examine the skin in the same order every time. This will help prevent you from skipping a body part. We will start with our patient seated. Stand in front of the patient. If adjustable, adjust the table to a comfortable height. Remember, your back is important. Avoid unnecessary twisting, stooping, and bending, all of which can take their toll. Wiping a lesion with alcohol prior to examination can remove any dead, cornified keratinocytes and aid in visualization of features of the lesion. Start by examining the hair and scalp. Separate the hair to examine the scalp from one side to the other. You may need to use your fingers or a cotton-tipped applicator to separate the hair to see the scalp. Remember to inspect the front and back of the ears, as they are common locations for skin cancers. Now inspect the head and neck. Inspect the face, including the conjunctivae, sclerae, eyebrows, eyelashes, lips, and oral cavity. As you progress through the exam, you will need to move the gown to see each area. Ask permission first by saying, I'd like to separate the gown to look at your back now. Is that okay? Now inspect the shoulders, arms, hands, and fingernails. Remember to palpate skin findings as you move along. Throughout the exam, explain to the patient what you are looking for and why. It is important for you to inspect and palpate skin lesions, focusing on key features that help distinguish if lesions are benign or suspicious for malignancy. When looking at skin lesions for possible skin cancer, explain what particular lesions are and if they are normal, if they should be watched, or if the patient should see a doctor. Now inspect the chest and abdomen, preparing the patient by saying something like, Let's look at your chest and abdomen. The patient will generally help by lowering or raising the gown to expose these areas. Do not forget to cover the patient back up when you are finished. Now let the patient know that you will be inspecting the thighs and lower legs. You will need to move the gown to see each area. Now let the patient know that you will be inspecting the thighs and lower legs. You and the patient can work together to expose the skin in these areas, moving down to the feet and toes. Remember to inspect the soles as well as the skin between the toes and the nails. Now ask the patient to stand so that you can inspect the back and posterior legs. If needed, ask the patient to lower their underwear to uncover the buttocks. Examination of the breasts and genitalia may be saved for last. Remember to consider patient comfort and use a chaperone during this part of the exam. We've demonstrated how you might progress through the exam with the patient sitting then standing. Now we will demonstrate how you would examine them lying down. Start by inspecting the scalp, forehead, face and neck. Move down to the anterior arms, hands and nails, then the chest and abdomen. Prior to examining the breasts or genital area, pause and ask the patient's permission to examine the area and to move or remove undergarments. Now proceed to the anterior thighs and lower legs and feet, including nails. Once you're done, ask the patient to flip over to look at the backside of their body. Be mindful of patient safety as they move on the bed and ensure they are not getting too close to the edge. Look at the posterior scalp, posterior ears, posterior neck and shoulders. Look at the posterior arms and their back. If they are wearing undergarments, ask for permission to lower their undergarments to look at their buttocks. Then replace the undergarments. Look at the posterior thighs, posterior lower legs and soles. Sometimes lighting determines whether the sit-then-stand approach or the lying-down-then-flip-over approach is better. Patients may have a preference as well, as may you as the examining provider. Regardless of which approach you use, try to examine the skin in the same order each time so you don't forget to look at any part of the patient. For patients with limited mobility, such as wheelchair-bound patients or bed-bound patients, you will usually require some assistance. Patients with limited mobility should be examined with an attendant in the room to help uncover the patient and stabilize them during the exam. For wheelchair-bound patients, if able to undress or mostly undress, have them do so before you go in to examine them. Since it will take extra time. Usually, you will need to adjust the sitting and standing approach for wheelchair-bound patients, making sure the wheelchair is locked in place for safety. Additionally, you will generally need to work with the assistant to help them stand up or lie face down, if they are able, so you can examine their back, buttocks and posterior legs. Remember, if you are able to undress or mostly undress, have them do so before you go in to examine them. Remove socks and compression garments to look at the lower legs and feet. For bed-bound patients, usually in the inpatient setting, you will similarly need to get help from assistants or nurses to see the skin. Often, not only will the hospital gown need to be moved, but you may have to remove dressings or compression hose to evaluate the patient. Since your nursing staff will be with you for the entire exam, they can help roll the patients to the side to see their backs, buttocks and posterior legs. Involving nurses and respiratory therapy technicians is critical for patients connected to ventilators, intravenous lines or other medical equipment. For both wheelchair-bound and bed-bound patients, pressure ulcers are a concern, and the skin exam should look for signs of pressure ulcerations. For more information on the evaluation of suspicious lesions, we recommend reviewing the learning modules on pigmented lesions and skin cancers in the Basic Dermatology Curriculum website. In addition, the American Academy of Dermatology has numerous educational resources available through the Spot Skin Cancer Public Awareness Campaign, accessible through the main aad.org website. Premium.

skin cancer screening exam

dermatologic conditions

referring patients

actinic keratoses

basal cell carcinomas