Checklist

WIPER

• Good light source. Lesion and loco-regional lymph nodes exposed.

Physiological parameters

• Ask: ‘Where is the lesion?’

• Ask: ‘Is the lesion painful?’

System

• S-E-I-S (Site, External, Internal, Surroundings)

Skin type

• Fitzpatrick classification of skin type

Site

• Location of lesion

• Number of lesions

External features

• Size (in cm)

• Shape:

• smooth or irregular edge

• flat or raised profile

• Surface:

• skin: intact or ulcerated skin, skin adnexae

• colour/pigmentation and telangiectasia

• colour distribution: regular vs. irregular

• discharge: blood, pus, lymph

• Scars from previous surgery (skin lesions or lymphadenectomy)

Internal

• Consistency: soft, hard

• Content: gas (crepitus), fluid (fluctuant and transilluminable), solid (nontransilluminable)

• Dynamic interaction: pulsatile, reducible, indentable, compressible

• Mobility and attachment to surrounding structures (above, below and laterally)

• Percussion: dull or resonant (gas, fluid, solid)

• Auscultation: bruits, bowel sounds

Surroundings

• Assess surrounding skin: normal or satellite lesions.

• Palpate for local, regional, general lymphadenopathy.

• Assess nerves: local and distal sensory and motor functions.

• Assess vascular supply of lesion: capillary refill time and pulses.

• Palpate liver for an irregular edge or enlargement and vertebral spine for tenderness if concerned about metastatic deposits.

Tip

The examination of a lump is very poorly done in general, due to a lack of a systematic or anatomical way of approaching the lesion. Palpation in particular needs to be structured as described above in order to avoid redundant gestures.

Tip

Beware the melanoma patient with a prosthetic eye or ear.