SKIN

HEALTH HISTORY

 Growths
 Rashes
 Hair loss or nail changes

ABCDEFG

 Asymmetry - Of one side of mole compared to the other

 Border irregularity - Especially if ragged, notched, or blurred
 Color variations - More than two colors, especially blue-black, white (loss of pigment due to regression), or red
(inflammatory reaction to abnormal cells
 Diameter >6 mm Approximately the size of a pencil eraser
 Evolving Or changing rapidly in size, symptoms, or morphology
 Elevated
 Firm to palpation
 Growing progressively over several weeks

Primary lesion:

 Primary lesions are flat or raised.

o Flat: You cannot palpate the lesion with your eyes closed.
 Macule: Lesion is flat and <1 cm.
 Patch: Lesion is flat and >1 cm.
o Raised: You can palpate the lesion with eyes closed.
 Papule: Lesion is raised, <1 cm, and not fluid filled.
 Plaque: Lesion is raised, >1 cm, but not fluid filled.
o Vesicle: Lesion is raised, <1 cm, and filled with fluid.
o Bulla: Lesion is raised, >1 cm, and fluid filled.
o Other primary lesions include erosions, ulcers, nodules, ecchymoses, petechiae, and palpable purpura.
 Number: Lesions can be solitary or multiple. If multiple, record how many. Also consider estimating the total
number of the type of lesion you are describing.
 Size: Measure with a ruler in millimeters or centimeters. For oval lesions, measure in the long axis, then
perpendicular to the axis.
 Shape: Some good words to learn are “circular,” “oval,” “annular” (ring-like, with central clearing), “nummular”
(coin-like, no central clearing), and “polygonal.”
 Color: Use your imagination and be creative. Refer to a color wheel, if needed. There are many shades of tan and
brown, but start with tan, light brown, and dark brown if you are having trouble.
o Use “skin-colored” to describe a lesion that is the same shade as the patient’s skin.
o For red lesions or rashes, blanch the lesion by pressing it firmly with your finger or a glass slide to see if
the redness temporarily lightens then refills.
 Texture: Palpate the lesion to see if it is smooth, fleshy, verrucous or warty, or scaly (fine, keratotic, or greasy
scale).
 Location: Be as specific as possible. For single lesions, measure their distance from other landmarks (e.g., 1 cm
lateral to left oral commissure).
 Configuration: Although not always necessary, describing patterns is often very helpful.