Stanford Medicine 25’s Resources to Help Physicians Promote Skin Health
September 22, 2023 – by Lindsay Paulsen, Media Logic
Skin health is always a relevant topic in the clinical setting, but it’s particularly worthwhile to revisit after the summer season, during which many people are exposed to high levels of sun damage.
The Prevalence of Skin Cancer
The American Academy of Dermatology Association (AADA) states that skin cancer is the most common form of cancer in the United States and it’s estimated that more than 9,500 people in the U.S. are diagnosed with the disease each day. Melanoma cases are also on the rise: rates doubled from 1982 to 2011 and continue to climb.
Disparities in Skin Health
Although anyone can develop skin cancer, AADA states that health outcomes differ for people of color. For this population, skin cancer is often diagnosed in later stages and is more difficult to treat. People of color are more at risk of skin cancer in areas that aren’t typically exposed to the sun, such as the hands, feet, groin and inside of the mouth. Research also indicates that people of color are less likely than Caucasian patients to survive melanoma.
With this in mind, it’s important to take all opportunities to screen all patients for skin cancer and other skin abnormalities. Following, we’ve gathered Stanford Medicine 25’s basic tips and resources related to skin health to support learning.
Stanford Medicine 25’s Tips for the Dermatology Physical Exam
- A proper dermatology exam requires good lighting. In addition to a well-lit room, you may need a hand-held light. Stanford Medicine 25’s Justin Ko, M.D., also recommends having a ruler and magnifying glass available.
- Before you can make a diagnosis of any skin lesion, it's important to be able to accurately describe skin lesions by their morphology, size, demarcation, color and distribution.
- “Morphology” is the common language we use to describe skin lesions and notes the general appearance of the skin lesion without regard to its pathogenesis or its underlying etiology.
- Don’t forget to palpate! “Remember that sometimes the palpation of skin lesions can be just as important as what you see,” Ko explains.
Click the button below to see our outline of basic language associated with the dermatology exam and be sure to catch Ko’s exam demonstration below!
Some patients may also have more than one skin lesion. Below, Stanford Medicine 25's Bernice Kwong, M.D., demonstrates the approach to complex, multiple rashes. “In our approach to the patient with multiple rashes, it is important to examine certain body parts that may give us clues to the diagnosis,” she says. For example, take a close look at your patient’s nails, elbows and scalp.
Examining Nevi (Moles)
During a dermatology exam, you may encounter nevi or moles. All moles should be taken seriously, as they may represent cancer. Normal moles are symmetric, smaller than 6 millimeters and are one color.
“When I look at a patient who we’re doing a full body skin exam on, I always start by trying to get a general feel for how many moles there are and how they’re distributed,” says Stanford Medicine 25’s Jennifer Chen, M.D.
If screening for melanoma, be systematic in your exam, from your patient’s head to their toes. Make sure you don’t miss areas including the conchal bowls, medial canthi, inner gluteal cleft, perianal region and between the fingers and toes.
Learn more about abnormal findings in the nevi exam here and watch Chen’s demonstration below.
A Closer Look at Acne
Acne is also a common dermatologic finding and although it isn’t typically a serious health threat, it can disrupt quality of life and lead to permanent scarring. Acne vulgaris and acne rosacea are two commonly seen rashes that affect the face. While the two are often confused by patients given their looks, both conditions are characteristically distinct in the ways they affect the skin.
Acne vulgaris (commonly referred to as acne) is a common skin disease in which hair follicles become clogged with dead skin and oils resulting in inflammation. On the other hand, acne rosacea (commonly referred to as rosacea) is a common skin disease that is characterized by redness, papules, pustules and swelling. Commonly mistaken for acne vulgaris in its early stages, acne rosacea is a relapsing condition and can be exacerbated by sun exposure, heat, alcohol, strong emotions, caffeine and spicy foods.
Read more details about acne vulgaris and acne rosacea here and see Chen’s demonstration below.