Skin exam

are patients required to be nude for a complete skin exam?

[Vanessa Lacuesta]

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.

[searcher67]

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.

[Vanessa Lacuesta]

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.

[searcher67]

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.

[Vanessa Lacuesta]

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.

[searcher67]

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.

[Pargolfer]

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!  

[Alfred221]

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.