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Skin exam
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Skin exam

are patients required to be nude for a complete skin exam?
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10 Comments Post a Comment
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Avatar_dr_f_tn
Hi,

Not necessarily especially if the patient's chief complaint is very localized, say the face.If the physician however, feels that the complaint may be a manifestation of an underlying systemic disease or if there is an associated generalized problem then, a thorough examination may be necessary.

Theoretically and ideally though, any physical examination in a clinician's clinic may require full body inspection and examination.This requires the patient to remove his/her clothes.This may be uncomfortable to the patient initially.A nurse or an assistant is usually around to make you feel at ease and comfortable.
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Avatar_n_tn
Thank you for your reply.  The exam has been recommended due to sun damage and exposure as a child.  I assume in this case the last paragraph applies.
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Avatar_dr_f_tn
Hi,

Yes, even in nondermatologic cases ,removing the clothes may be necessary since there are diseases that may manifest as localized signs of discolorations or a simple rash on the scalp. However,further examination and a complete medical examination, may actually show associated conditions in other parts of the body.

In your case, the extent of sun damage may need to be ascertained. If we are considering burns here, then the physician usually maps and calculates the area involved as this may be used for management.
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Avatar_n_tn
I had the exam today.  I did have to reomove all clothing and was given a lap drape.  I used it until midway thru the exam.  There were a number of "AK's" that were frozen.  These were on my ear, shoulders, back and lower legs.  In retrospect the freezing was somewhat painful but over all the exam was not as unpleasant as a mammogram or pap smear.  It is also not a unpleasant as skin cancer would be.
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Avatar_dr_f_tn
Hi,

With "AK's" you meant actinic keratosis ?

Physical examination is not really an unpleasant experience given that there is good patient and doctor relationship.It is necessary that as a patient you discuss your fears and concerns with your physicians .This will help us physicians choose the best and the most appropriate treatment that will suit your needs.
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Avatar_n_tn
Hi Vanessa,
     Yes actinic keratosis is what was frozen.  Today they are small scabbed over areas.

     I understand exams shouldn't be unpleasant intellectually but emotionally is more difficult.  I suppose this is due to childhood traumas.  I am working on this issue.

     Again, thank you for your replies.
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Avatar_n_tn
Hi, Dr. LaCuesta.  I posted the following, but the response by another doctor indicated that he didn't really read the entire question or I hadn't written it clearly enough.  Would you please take a look and let me know your opinion?  As a guy, I'm interested in a woman's perspective, as is my wife, and how I should address the concern.  Thank you!

Extent of Skin Exam
by Pargolfer

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Pargolfer
Member since Sep 2008  

Sep 02, 2008 02:11PM
Tags: Skin exams
Am a 65 yr old male who had basal cell once on arm, father had melanoma (died), as did two uncles, and I am blue eyed, sunburned frequently as child, and was often in sun in work.  Have not had melanoma yet, but have been advised by a younger relative who is a pediatrician that I am at high risk, should have complete skin exam, including where sun doesn't shine.  I sought same recently (female dermatologist), but the exam was primarily a review of my face and arms, with a cursory glance at legs and back with underwear on. Then biopsied three spots on arm, near where I had the basal.  Wife (who has Parkinson's and has had squamous), is concerned that I should have EVERYTHING checked, including genitals and certainly a closer look at legs, since I've had several things biopsied there in past and am supposedly a "high risk" patient due to my father's bout with melanoma. I have no problem with "down there," but don't want to insist if it's not necessary or appropriate, esp with a female doctor. I can't see everywhere with my bifocals to do self-exam.  Was wondering also, since I'm in North Carolina, if it's something that's not done in the "south" because of modesty concerns or because of new information in medical schools that says it's not necessary? Or, because there is so much emphasis on appearance and cosmetic dermatology, wonder if dermatologists have shifted emphasis these days?  Please advise. Thanks!  
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Avatar_m_tn
As a male in my mid 50's, I have had to undergo twice a year complete skin exams since my early teen years.  As a child, had been molested by my pediatrician, so I felt very uncomfortable wearing a gown or underwear only to have it reached into for the exam.  In my 20's I was able to find female family physicians and dermatologists whom I felt very comfortable with.  A few of them would have me take off everything for the exam (one allowed me to be toltally undressed before she came in so that I could be calmed down before she came in) and stand there completely naked in front of her and the nurse.  This was emotionally a lot easier than to have to have a peek a boo show.  I felt a lot more confident about the exam when the doctor takes their time instead of hurrying through the exam since my life depends on it. If only doctors and nurses would ask the patient how they are more comfortable about the exam being done, such as gown, sheet, underwear, or completely naked, would help the patient feel better about the exam.
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Avatar_m_tn
Had full body skin exam done with underwear on . Female doctor did a 5 sec peek a boo at genital area and on turn over pulled underwear down to look at cheeks. Whole thing was done quickly and feel like I didn't get a good exam. I thought they were suppose to be done nude and looked at every inch of you. Both my parents have had skin cancer. Has anyone else had something like this and feel cheated?
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Avatar_m_tn
I would say that yes you were cheated. Your health care is your decision and the level of care you get, or dont get, makes up your own mind on whether you got the right care or not. Making a mention of feeling cheated seems to be an underlying factor in your report that you felt cheated, which means you were cheated. Your overall health is solely your own responsibility. If you had a concern in a certain area of your body, you should have spoken and informed the good doctor. If you were not examined after saying such, then again, yes, you were cheated.
I recently had a follow up skin exam where both the nurse and the doctor asked if I had any concerns. I told them both and was asked to strip and drape a paper sheet over my lap until it was time to remove it. After examining my head and neck she moved to my chest and arms. Moving my arms around caused the drape to slide off my lap, a lot. I simply asked her if I could discard the drape, she told me she was fine with that if I was. The drape was discarded and I remained nude fro the rest of her examination. She checked every inch of my skin from scalp to toes. I have a few spots under concern of hers, one of which she wants me to see her partner Doctor for, and I have to go back in three months to see her again.  
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