Detailed Skill Performance Evaluation: Skin, Hair, and Nails Examination

Directions: You will have 10 minutes to complete the skill. All critical (C) steps and 80% of the noncritical steps
must be performed or verbalized. Special tests (S) will be performed if requested by the examiner.
Start: End:
Performed Verbalized
Washes hands and dons appropriate personal protective equipment. C

Introduces self to patient using first and last name. Y/N

Notes general appearance and vital signs. Y/N

Inspection (Students can combine inspection and palpation for a better exam flow.)
1. Assess color: erythema, pallor, cyanosis, or jaundice (Pallor: Look at fingernails, lips,
mucous membranes; palms and soles in dark-skinned people. Cyanosis: Look at lips, oral
Y/N Y/N
mucosa, tongue, nails, hands, feet. Jaundice (yellowing): Look at sclerae, conjunctivae, lips,
hard palate, tongue, and skin in general [need penlight].)
2. Look for areas of hypo- or hyperpigmentation (Examine upper and lower extremities,
Y/N Y/N
trunk, and face.)
3. Scalp hair: assess distribution and quantity and examine any scalp lesions (Look at head
Y/N Y/N
and scalp; must part hair.)
4. Nails/nail beds: note color, shape, and any lesions (Look at finger and toe nails and note
Y/N Y/N
condition in all four extremities.)
5. Note characteristics of any lesions: color, location, distribution, pattern, size (in mm),
Y/N Y/N
shape, and type (Look for lesions on trunk and extremities including palms and soles.)
Identify any nevi and apply the ABCDE method to screen for melanoma: Asymmetry,
Y/N
Borders, Color, Diameter, Evolution
Palpation
1. Skin temperature: check for localized or generalized warmth or coolness (Feel upper and
lower extremities [anterior and posterior] with back of hands; must include fingers and Y/N Y/N
toes.)
2. Check skin moisture and texture (Feel upper and lower extremities [anterior and
Y/N Y/N
posterior] with fingertips; must include fingers and toes.)
3. Assess skin turgor (Pinch skin over one dorsal hand.) Y/N Y/N

4. Palpate hair texture (Palpate hair in at least two places.) Y/N Y/N

5. Palpate fingernails and toenails Y/N Y/N

Adequate exposure was for all inspection steps. C

Adequate draping was maintained for all steps. C

Evaluation: #Y = #C =
min. = 18/23 min. = 3
Comments on quality of performance: Needs remediation?

Y/N

Developed by Albany Medical College, Center for Physician Assistant Studies | Bickley: Bates’ Guide to Physical Examination
and History Taking, Twelfth Edition. Copyright © 2017 Wolters Kluwer Health