The total skin examination includes inspection (and often palpation) of the entire skin surface from scalp to feet

• The examination should be systematic* so as not to miss any important areas
• “Easily missed” areas of the body includes:
  • post auricular creases,
  • the conchal bowls of the ears,
  • the medial canthi of the eyes
  • the alar grooves of the nose (as well as other creases on the face)
  • the interdigital spaces and bottoms of the feet

Full Skin Exam

<aside> 💡 Skin, hair, nail lesion

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1. Start with the patient sitting at the edge of the hospital bed, facing you with their legs hanging over the edge
   • Head & Neck
     • Scalp and hair (ask the patient to remove any clothing or hairpieces)
     • Face, ears, neck
     • Eyes (external structures)
     • Mouth (hard and soft palate, tongue, buccal mucosa)
   • Upper extremities
     • Proximal and distal arms, axilla
     • Dorsal and palmar aspect of hands, in-between fingers
     • Fingernails
2. Tell the patient you will be lowering their gown to examine their chest and abdomen.
   • Trunk (anterior)
     • Chest, abdomen, umbilicus, suprapubic area
3. Re-drape the chest, and tell the patient you will be looking at their legs now.
   • Lower extremities
     • Proximal and distal legs
     • Inner thighs/groin (intertriginous areas)
     • Dorsal and plantar aspects of feet, in-between toes
     • Toenails
4. Ask the patient to stand and turn their back to you. Tell the patient you will be examining their back, then their buttocks and the backs of their legs. Posterior
   • Back, including backs of arms and posterior neck
   • Buttocks
   • Posterior legs
5. Re-drape the patient and let them know that the physical exam is complete.

Reporting

• Skin Rashes