Dermatological skin examination

Assessing lesions

  • Distribution and size
    • e.g. acral (distal), central, flexor/extensor, localised/generalised, dermatomal, follicular, seborrhoeic 
  • Characteristics (SEC)
    • Shape, e.g. circular, linear, annular, irregular
    • Edge and elevation, e.g. well-demarcated, ill-defined, raised/flat
    • Colour, e.g. erythematous, depigmented/pigmented, purpuric
  • Secondary features 
    • e.g. crust, scale, pigmentation, keratosis, lichenification, erosion, excoriation, fissure, ulceration

Definitions in dermatology

 <1 cm>1 cm
FlatMacule Patch 
Plaque (palpable)
 <0.5 cm>0.5 cm
Vesicle (fluid-filled)
Pustule (pus-filled)
Bulla (fluid-filled)


  • Wash hands
  • Introduce self;
  • Ask Patient’s name, DOB and what they like to be called
  • Explain examination and obtain consent
  • Get a chaperone
  • Expose patient to underwear

General inspection

  • Patient: well/unwell, pain/discomfort
  • Describe the pattern of any rash: site, number of lesions, distribution pattern


  • Nails
    • Psoriatic nail changes (pitting, onycholysis, subungual hyperkeratosis)
  • Hands

Upper limbs

  • Anterior arms
  • Ask patient to put hands behind head
    • Posterior arms
    • Axilla

Head and neck

  • Scalp: look through hair and behind ears
  • Face
  • Inside mouth


  • Chest
  • Abdomen
  • Back
  • ‘At this point, I would also like to look at the genital region.’

Lower limbs

  • Legs
  • Feet and toe nails

To complete

  • Thank patient and restore clothing
  • ‘To complete my examination, I would examine any suspicious moles with a dermatoscope and perform other relevant system examinations (e.g. vascular for an arterial ulcer).’ 
  • Summarise and suggest further investigations you would consider after a full history

Try some questions

What is Nikolsky’s sign?

Oops! This section is restricted to members.

What are the skin findings in dermatomyositis?

Oops! This section is restricted to members.

What is the definition of erythroderma?

Oops! This section is restricted to members.

What are the different types of psoriasis?

Oops! This section is restricted to members.

Try some OSCE stations

  1. Try a normal exam first
  2. Psoriasis
  3. Actinic keratosis
  4. Eczema
  5. Neurofibromatosis
  6. Find more OSCE stations here

Your email address will not be published. Required fields are marked *

Join our email list!
For free OSCE tips and updates