Skin checks in the emergency department
Most patients do not get skin checks as often as they should.
The other day I had a 12-year-old patient that presented for a minor emergency. While I was listening to his lungs, I was looking at his back. Through the separation of his gown, I noticed a black, irregular-looking mole. This child was fair skinned and had a sunburn already, so I could tell he was no stranger to the sun. I looked up at his parents and mentioned that they should take their child to a dermatologist to have the mole looked at closer.
“That's funny that you mention this,” the mother stated, “because I wouldn't expect you to care about unusual moles in the emergency department.”
As it turns out, the child was already being closely followed by a dermatologist for this mole. But her comment intrigued me. I realized that in the emergency department, as well as in other areas of medicine, providers are presented with unusual opportunities to evaluate patients for something that may never cross their minds – skin checks.
Since I am a redhead, I constantly stare at my skin. I have a close relationship with my dermatologist, and I've already had some close encounters with skin cancer. Combine this with my medical background, and I've turned into someone who is constantly screening my family for unusual spots on their skin without even realizing it. But for patients coming into the emergency department, routine skin checks may be something they don't think about doing. This is where providers can help. If a patient comes in for back pain, I am going to be looking closely at their skin. If I'm looking for bruises, erythema, abrasions, rashes, or other abnormalities, I might as well be looking for moles too. After all, this may be the first time someone has looked at this person's back in years.
Although providers want patients to get yearly physicals, many people do not. And unless the patient is going to be evaluated specifically for a skin check, there may be parts of their skin that go unexamined during their physical exam. When is the last time you've had your popliteal fossa thoroughly examined? Exactly. But if a patient comes in with calf pain, I'm looking at it. Heck, I might be the only person that's seen their popliteal fossa in years. So if I see a funky looking mole while I'm performing my exam, it's worth mentioning because you never know when this patient is going to have the same area checked over again.
Thinking back to the mother that was surprised I mentioned her son's mole, I can't help but smile. Performing skin checks may not be considered an emergency, and it may come as a surprise to your patient if you mention it. However, it is still an important aspect of staying healthy. While it might not be immediately apparent, it could be the incidental finding that saves your patient's life.
Jillian Knowles, MMS, PA-C, works as an emergency medicine physician assistant in the Philadelphia area.