Skin Lesion Approach

– History –

  • CC:
    • Site: where? Other places (oral)? Same place always?
    • Onset: first time? When? Sudden\gradual? Progress\regressing?
    • Characteristics: Painful? Itches? Ulcerates? Bleeds? Color? Has it changed in character, in general?
    • Aggravating\relieving factors: topical creams, sun exposure, food?
    • Risk factors:
      • Previous history
      • Family hx
      • Freckles (light skin, blue eyes)
      • Immunosuppression: DM, SLE, renal transplant, HIV, steroids,
      • Skin conditions: xeroderma pigmentosum, dysplastic nevus syndrome
      • Carcinogen exposure: UV (tan), radiation, arsenic
      • Chronic ulcers, burns, lichen planus
  • Associated sx:
    • Constitutional: fever, wt loss, loss of appetite, night sweats, chills, fatigue?
    • Sx of Mets: lymph node swelling?
  • PMHx:
    • Diseases:
      • Chronic ds (HTN, DM, DLP)
      • Malignancy
    • Medications
    • Surgery, hospitalization, trauma
    • Blood transfusions, IV drug use, tattoos
    • Allergies
  • FMHx:
    • Similar complaint?
    • Same diseases as in PMHx?
  • Social Hx:
    • Occupation, marital status, children?
    • Smoking, alcohol, recreational drugs?
    • Travel Hx
    • Diet, exercise


– Physical Exam –

  • The lesion: ABCDE (asymmetry, border, color, diameter (> 6 mm), evolving)
  • Total body examination (including mucous membranes and nail plates)
  • LN examination


– Investigations –

  • Punch biopsy -> if melanoma; stage it accordingly
  • LN clearance


– Management –

  • Wide local excision with margins according to the type
  • Strongest predictor of recurrence is depth


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