Physical examination maneuver
Skin Inspection and Palpation
How to Perform
With the patient undressed and wearing a gown open in the back with a drape across the lap, begin the examination in a warm room under bright light with the patient sitting upright on the examination table, with the head of the table raised about 45° behind them but without the patient leaning against it.
Inspect the scalp, parting the hair or using a comb, then the ears and postauricular folds. With the gown open in the back, inspect the posterior neck and back. Move to the front of the patient and inspect the face, eyelids and conjunctivae, nose, lips, oral mucosa, and anterior neck.
Beginning on one side, examine the hand, palm, finger web spaces, and fingernails, then proceed proximally along the arm to the axilla. Move to the opposite side and repeat the same sequence.
Lower the gown to expose and inspect the upper chest above the breasts. Then have the patient briefly lower the gown below both breasts and inspect the breasts, then have the patient replace the gown.
Have the patient lie back and extend the pull-out leg rest, keeping the drape across the lap. Have the patient raise the gown to expose the abdomen and flanks and examine these areas. With the breasts still covered by the gown, ask the patient to lift both breasts to expose the inframammary folds and inspect these areas, then have the patient lower the gown.
Examine the toes, toe web spaces, toenails, soles, and remainder of both feet. Move the drape progressively upward while examining the anterior, medial, and lateral surfaces of both lower legs and thighs. Expose and inspect the groin and external genitalia, then re-drape the lower body.
Have the patient stand facing away from you. With the back of the gown open, inspect the buttocks, gluteal cleft, perianal skin, posterior thighs, and posterior lower legs to complete the examination.
Throughout the examination, note skin color, vascularity, moisture, and hair distribution. For any lesion, note its location, distribution, configuration, type, size, and color, using a dermatoscope where available. Palpate as needed to assess skin temperature, moisture, texture, thickness, turgor, and mobility, and assess any lesion for consistency, tenderness, depth, and fixation.