Test: Skin Inspection - Thorax

Video Link

Background/Purpose

Skin lesions can be categorized as primary or secondary, although the distinction isn't always clear. Make sure you use the correct term to describe any lesions you find. The following are primary lesions:
macule, a flat, nonpalpable circumscribed area (up to 1 cm) of color change that's brown, red, white, or tan
patch, a flat, nonpalpable lesion with changes in skin color, 1 cm or larger
papule, an elevated, palpable, firm, circumscribed lesion up to 1 cm
plaque, an elevated, flat-topped, firm, rough, superficial lesion 1 cm or larger, often formed by coalescence of papules
nodule, an elevated, firm, circumscribed, palpable area larger than 0.5 cm; it's typically deeper and firmer than a papule
cyst, a nodule filled with an expressible liquid or semisolid material
vesicle, a palpable, elevated, circumscribed, superficial, fluid-filled blister up to 1 cm
bulla, a vesicle 1 cm or larger, filled with serous fluid
pustule, which is elevated and superficial, similar to a vesicle, but is filled with pus
wheal, a relatively transient, elevated, irregularly shaped area of localized skin edema. Most wheals are red, pale pink, or white.

Secondary lesions can be caused by disease progression, overtreatment, excessive scratching, or infection of a primary lesion:
scale, a thin flake of dead exfoliated epidermis
crust, the dried residue of skin exudates such as serum, pus, or blood
lichenification, visible and palpable thickening of the epidermis and roughening of the skin with increased visibility of the normal skin furrows (often from chronic rubbing)
excoriation, linear or punctuate loss of epidermis, usually due to scratching.

Procedure

Examine the patient in good lighting

Inspect skin for the following:

Color: Contrast with color of mucous membrane.
Texture
Moisture
Pigmentation
Lesions
Hair distribution
Normal:
Color varies based on race (black, white etc) and environmental effect (tan).
Few moles and areas of depigmentation can be encountered.
Fine hair is seen over most of the skin.
Hair distribution varies based on sex.
With aging
Texture and turgor changes. Loss of stretch and resilience.
They tend to be dry.
Aging spots: Irregularly pigmented melanocyte loss.
Performed: Bilaterally

Dialog

Visual inspection of the thorax

Criteria

• Normal appearance
• Uniformity of pigmentation/coloration
• Minimal moles or raised areas
• No vesicles, reddness or swelling.

Measurement

LOINC Code

Scale/Grading

selection range; grade - LOINC ID
Option - Value option selection range; grade - LOINC IDPass ; Pass - Fail ; Fail -