• Good light source. Lesion and loco-regional lymph nodes exposed.
• Ask: ‘Where is the lesion?’
• Ask: ‘Is the lesion painful?’
• S-E-I-S (Site, External, Internal, Surroundings)
• Fitzpatrick classification of skin type
• Location of lesion
• Number of lesions
• Size (in cm)
• smooth or irregular edge
• flat or raised profile
• skin: intact or ulcerated skin, skin adnexae
• colour/pigmentation and telangiectasia
• colour distribution: regular vs. irregular
• discharge: blood, pus, lymph
• Scars from previous surgery (skin lesions or lymphadenectomy)
• Consistency: soft, hard
• Content: gas (crepitus), fluid (fluctuant and transilluminable), solid (nontransilluminable)
• Dynamic interaction: pulsatile, reducible, indentable, compressible
• Mobility and attachment to surrounding structures (above, below and laterally)
• Percussion: dull or resonant (gas, fluid, solid)
• Auscultation: bruits, bowel sounds
• Assess surrounding skin: normal or satellite lesions.
• Palpate for local, regional, general lymphadenopathy.
• Assess nerves: local and distal sensory and motor functions.
• Assess vascular supply of lesion: capillary refill time and pulses.
• Palpate liver for an irregular edge or enlargement and vertebral spine for tenderness if concerned about metastatic deposits.