1. Environment
2. General inspection
3. Inspect: entire skin, lesions
4. Palpate: lesions, nodes

Environment

• N/A so far.

General appearance

• Pt undresses, so entire skin can be examined.
• Pt. is scratching.

Inspect: entire skin

• Dry skin (hypothyroid).
• Thick skin (acromegaly, androgens).
• Thin skin (Cushing's, hypothyroid, liver dz).
• Stretched skin (scleroderma).
• Scratch marks.
• Swollen lymph nodes.
• Systemic rash.

Inspect: lesion

• Location:
  • Sun exposed vs. covered.
  • Asymmetrical vs. symmetrical.
  • Number.
  • Peripheral vs. trunk.
  • Hallmark locations. See Hallmark Rashes Reference. 
• Pattern:
  • See Skin Lesion Patterns Reference.
  • Discrete vs. confluent.
• Colour.
• Size.
• Shape.
• Edges:
  • Well demarcated vs. poorly demarcated.
• Surface:
  • Scaling, crusting.
  • Shiny vs. dull.
  • Thickening, blistering.
  • Ulceration, skin breaks, fissures.
  • Elevation.
• Discharge, bleeding.
• Type of lesion. See Skin Lesion Terminology Reference.

Palpate: lesions

• Ask pt. if tender, first.
• Palpate lesions/masses. See Examining A Mass Reference.
• Flat vs. raised.
• Temperature (inflammatory).
• Apply pressure:
  • Blanches on pressure.
  • Doesn't blanche on pressure (purpura).
• Record type of lesion. See Skin Lesion Terminology Reference.
• See if similar lumps can be found elsewhere (eg RA nodules).

Palpate: nodes

• If inflammation or carcinoma: palpate draining nodes for the lesions.
• See Nodes Reference.