Teledermatology for suspected skin cancers

Total body and skin lesion examination

Created 2017.

Ensure good lighting. If necessary use an examination light, torch or ideally, large low-magnification dermatoscope.

• Total body includes oral mucosa.  Genital examinations may be undertaken sensitively at times of prostate examination, cervical smear.
• Scalp – use a comb or pencil to part hair  
• Behind ears, under arms, in the groin, buttocks, between fingers and toes
• Fingernails and toenails

Determine what’s normal for the individual:

• Fitzpatrick Skin Phototype
• Hair and eye colour
• Degree of sun damage
• Which body sites are affected?
• Especially note actinic keratoses, solar lentigines
• Pattern of melanocytic naevi
• Pattern of seborrhoeic keratoses
• Pattern of solar lentigines
• Congenital lesions, especially melanocytic naevi
• These should be stable (adult) or growing in proportion to the rest of the body (child)
• Inflammatory skin conditions, ulcers, scars, infections etc.

Identify solitary lesions that are different from the other lesions:

• These may be termed ugly duckling, black sheep etc
• Lesions suspicious of melanoma
• Lesions suspicious of keratinocytic skin cancer
• Lesions in which there is diagnostic uncertainty

Record the lesion size/location and photograph it.