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Evaluation of the Dermatologic Patient

By Elizabeth H. Page, MD, Assistant Clinical Professor of Dermatology; Staff Physician, Harvard Medical School; Lahey Hospital and Medical Center

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Patient Education

History and physical examination are adequate for diagnosing many skin lesions. Some require biopsy or other testing.

Dermatologic history

Important information to obtain from history includes

A negative history is as important as a positive history. The history of the particular skin lesions is also important, including time and site of initial appearance, spread, change in appearance, and triggering factors.

Dermatologic examination

Visual inspection is the central evaluation tool; many skin disorders are diagnosed by the characteristic appearance or morphology of the lesions (see also Description of Skin Lesions). A full skin examination, including examination of the scalp, nails, and mucous membranes, is done to screen for skin cancers and to detect clues to the diagnosis of a widespread eruption. Magnification with a hand lens can help reveal morphologic detail. A hand-held dermatoscope with built-in lighting is particularly useful in evaluating pigmented lesions. Further information can be gathered by using diascopy or a Wood light.