This article provides practical pearls for performing full body skin exams as shared by a panel of dermatology nurse practitioners (NPs) and physician assistants (PAs) during the 2022 DERM NP/PA CME conference.
Let’s Start with the Basics
What happens before we enter the room?
Before entering the room, it’s always best to:
- Review the patient’s chart for pertinent medical history, family history, medications, and skin history.
- Confirm their insurance to have an idea of expectations for medication coverage.
- Determine if there is a referral source.
During the Exam
Specific to NPs and PAs, it is essential to provide a professional and accurate introduction especially for new patients as well as extend a warm greeting for established patients. Steve Hawkes, PA-C, prefers to sit down and ask patients how they are. It’s helpful to ask patients if they’ve had a skin exam before so you can manage expectations about the exam. If not, explain the purpose of a full body skin exam and what to expect during the exam.
At the start of the exam, make sure to address the patient’s chief complaint or primary concern. Steve Hawkes, PA-C examines those areas first and then completes the remainder of the exam. Use a specific routine during each exam to prevent missing any areas. It’s helpful to have a medical assistant with you in every exam room, whether the patient is male or female. Steve recommends using a cotton tip applicator to part the hair while examining the scalp. A tongue depressor can be used to cover the ear canal if you are using cryosurgery on the ear. May use tongue depressor to protect the eye or other areas as well when performing cryotherapy. For a thorough exam, do not forget to examine the oral cavity. Inform a patient if you plan to palpate any areas and document any areas that are not examined such as the genitals.
What do you do if a patient has a list?
SIEZE THE LIST!
- Prioritize complaints.
- Consider having your MA help you look through a patient’s written list.
- Limit complaints to the top 3 concerns and reassure the patient that you will address the remaining concerns at their follow-up visit.
Here are some tips from Wendy Cantrell, DNP, CRNP
- Always encourage full body skin exams, especially for new patients.
- Ask about skin cancer history and document the location, timing, and treatment.
- For all treated skin cancers, examine and palpate the scar for recurrence.
- Perform eye exams in patients with a personal or family history of melanoma.
During the skin exam, mark biopsies as you go so your medical assistant can start setting up the procedure tray while you finish examining. Always explain why you are taking a biopsy. Having ongoing dialogue during the exam to explain your findings will build on trust and rapport. For example, if you use a dermatoscope, explain the purpose of this tool and how it works. For patients with mobility issues, have them stand, lay on their side, use pillows, or have someone help you with positioning during the exam.
A few take-home points:
- Have a routine for total body skin exams so you do not miss any areas!
- Documentation is important! If it’s not documented, it never happened!
- Have a MA in every room for help with documentation, procedures, and chaperoning.
Watch a recording of this case-based panel here.
This information was presented by a panel of expert faculty during the DERM2O22 NP/PA CME conference held July 28-31, 2022. The above highlights from the panel were written and compiled by Dr. Mojgan Hosseinipour.