Clinical Tips: Skin Checks, Acrylic Glue, and Talking to Patients

Keep these tips and pearls from dermatology experts in mind for your next appointment.

Tip 1: The General Skin Check, Step by Step

For us in dermatology, a full skin examination/skin cancer surveillance is akin to a yearly physical. Here are some things we should always consider:

1) Review the patient’s past records and past notes beforehand if possible. Make a mental note to follow up on any outstanding issues (eg, biopsy results, surgical experience/results, response to medical treatment, important life events that were coming up, patient communications in the electronic medical record).

2) Give the patient time to undress and place a gown on. Knock and ask permission before entering the room.

3) Introduce yourself and greet the patient warmly. Acknowledge and greet family members/guests that the patient has brought with them into the room. 

4) Introduce the members of your team that are with you today (eg, scribe, student, resident, nurse).

5) Sanitize your hands before entering the room, before examining the patient, after examining the patient, and after exiting the room. Make sure to use proper personal protective equipment such as gloves, masks, and eyewear.

6) After general pleasantries and small talk, ask the patient about their dermatologic concerns, both the reason for today’s appointment and any other general concerns. Follow up on any outstanding issues noted in the patient’s records.

7) Let the patient know when you are going to transition to the physical examination part of the visit.

8) Systematically examine and palpate the patient’s entire skin, paying close attention to the patient’s comfort and body language. Narrate your exam, especially when the patient cannot see you (ie, examination of back and posterior legs). Take the opportunity to educate the patient during their exam as well (eg, skin cancer statistics, the ABCDEs of melanoma, how to spot a seborrheic keratosis).

9) Ask permission before looking at sensitive areas such as the scalp and around undergarments, and ask the patient if they have any concerns underneath their undergarments.

10) Let the patient know what you have found/diagnosed and what you recommend for treatment or management. It is important to explain in simple, straightforward, and easy-to-understand language.

11) Allow the patient time to digest the information and make a choice for themself. Ask if they have any other concerns or if anything was not clear.

12) Let the patient know the next steps (ie, are you coming back into the room once they are dressed, should they go straight to check out, where their prescriptions were sent).

13) Thank the patient for coming in and let them know when you anticipate seeing them again (ie, next appointment). Always let the patient know to contact you or schedule an appointment sooner if a concern does arrive before their scheduled appointment. If asynchronous telehealth is an option, be sure to mention that as a contact method as well.

Dr William W. Huang

Winston-Salem, NC

Tip 2: Acrylic Glue to the Rescue

I recommend using acrylic glue for fissures on hands and feet, as well as using on cuticles of people with habit tic deformity. It’s a simple method that really works great. I just always warn people not to glue their fingers together when applying!

Dr Jules Lipoff

Philadelphia, PA

Tip 3: Watch Your Language

Patients and the general public get the wrong impression and are grossly misinformed when we use the term toxin to denote the botulinum toxins. We do not administer onabotulinumtoxinA as a neurotoxin any more than we administer acetaminophen as a hepatotoxin.

Dr Kevin C. Smith 

Niagara Falls, Ontario, Canada

Tip 4: Chronic Conditions Counseling

Chronic conditions such as atopic dermatitis and psoriasis need a 365-day a year maintenance plan, not just a 5-day treatment plan. 

Dr Seth Orlow

New York City, NY