Full Skin Examination

Full Skin Examination Current Concerns: - New mole on left upper back, noticed 3 months ago, with recent increase in size and irregular borders. - Persistent dry, itchy rash on elbows and knees for 6 months. - Concern about sun damage on face. Examination: - Face: Multiple solar lentigines on cheeks and forehead. Mild erythema on nose and central face. No suspicious lesions noted. - Ears: Bilateral actinic keratoses on superior helix, left ear larger (4mm). No other significant findings. - Scalp: Diffuse mild seborrhoeic dermatitis with fine scaling. No alopecia or suspicious lesions. - Neck: Scattered seborrhoeic keratoses, largest 5mm on posterior neck. No palpable lymphadenopathy. - Chest: Several benign melanocytic naevi, stable. Mild telangiectasias on décolletage. - Abdomen: Few scattered benign melanocytic naevi. No rashes or other abnormal findings. - Upper limbs: Bilateral actinic keratoses on extensor aspects of forearms. Multiple solar lentigines. Dry, erythematous, well-demarcated plaques with silvery scales on bilateral elbows, consistent with psoriasis. - Hands: Fine wrinkles, multiple solar lentigines. No nail changes or suspicious lesions. - Lower limbs: Bilateral varicosities on medial calves. Dry, erythematous, well-demarcated plaques with silvery scales on bilateral knees, consistent with psoriasis. No suspicious pigmented lesions. - Feet: Calluses on heels. No suspicious lesions or nail changes. - Buttocks: No lesions, rashes, or other abnormal findings. - Back: Asymmetrical, irregularly bordered pigmented lesion on left upper back, approximately 8mm in diameter, mixed shades of brown and black. Several benign melanocytic naevi. Plan: - Excisional biopsy of suspicious lesion on left upper back for histopathology. - Prescribe topical corticosteroid cream (betamethasone 0.05%) for psoriasis on elbows and knees, apply twice daily for 2 weeks. - Recommend daily broad-spectrum sunscreen use (SPF 50+) and sun-protective measures. - Schedule follow-up in 4 weeks to review biopsy results and assess psoriasis treatment response. - Patient education provided on ABCDEs of melanoma and importance of self-skin checks. Billing: - ICD-10 codes: D22.5 (Melanocytic naevi of trunk), L40.0 (Psoriasis vulgaris), L57.0 (Actinic keratosis), Z12.83 (Encounter for screening for melanoma)