What happens during a skin examination?

Skin examinations are a routine part of the physical examinations carried out during compulsory screening appointments for children in Germany (“U-Untersuchungen”) – starting with the “U1” examination in newborns, up to the “U9” examination at the age of five. Pediatricians look out for allergies, eczema or hemangiomas (strawberry birthmarks), as well as injuries such as bruises.

From the age of 35, adults in Germany are entitled to free skin cancer screening in a dermatology practice every two years. These examinations can be carried out by specially trained family doctors, too. In Germany, they are paid for by statutory health insurers.

Before looking at your skin, the doctor will ask questions about any skin problems and changes you have noticed, like where they first appeared, and whether they developed suddenly or over a longer period of time. If there are signs of an infection such as herpes, the doctor will ask you about possible sources of infection and whether there’s a chance you might have infected someone else. If you have signs of an allergy, you will be asked about possible triggers.

When looking for causes, you might also consider factors such as harmful substances in the workplace, stimulants such as alcohol and nicotine, sexual behavior, medication, known chronic medical conditions (e.g. diabetes), cancer, previous skin conditions, or skin problems that run in your family.

In the skin examination that follows, the doctor should take a very close look at your skin. Their eyes and hands are their main “tools” here.

In skin cancer screening, all of the skin on your body should be looked at, including the mucous lining inside your mouth, the skin on your scalp, nails, creases in your skin, and your genital area.

In order to describe skin changes as accurately as possible and to find out what is causing the changes, the doctor will be interested in the following:

• The type of skin change: Doctors distinguish between things like patches, lumps and blisters. The original skin change might lead to flaky skin, scabs, and sometimes even ulcers or scars.
• Color: Is the skin red, or is it yellowish or bluish in color, for instance?
• Texture of the skin: For example, does the skin feel rough or are there small, hard bumps?
• Borders: Do the outer edges look even or irregular? Are they clearly defined or blurred?
• Size, distribution, shape and location on the body: For instance, is a rash made up of small or large patches, are there any blisters, and is the skin flaky? Where on the body is it? Are the skin changes spread out over a larger area, do they form a straight line or a circular pattern, do they appear on one side of the body or symmetrically on both sides?
• Accompanying symptoms: Does the area of skin itch, burn, bleed or hurt?

Sometimes, areas of affected skin might not look typical for the disease – for instance, because they are scratched or inflamed. This makes it harder to diagnose the problem. Taking photos can make it easier to track the skin changes.

As well as looking at the skin, the doctor will feel the area with their hands to determine the texture of the skin and the tissue below it, to see how thick any skin changes are, and to find out whether they hurt.

Flaky skin and scabs can be removed using a wooden spatula, making it possible to see the skin underneath better. Wooden spatulas can also be used to check for signs of eczema: If the area of skin turns white rather than red after being rubbed vigorously, it could be eczema.

In order to see the actual color of skin changes, a glass spatula can be pressed against the skin. This temporarily forces blood out of the blood vessels, revealing the “true color” of the skin. Red patches caused by blood vessel changes then disappear, whereas changes in the color of the tissue are still visible.

Magnifying lens with a light source (dermatoscope): This special magnifying lens can be used to take a closer look at tiny changes, for instance changes in a mole.

Blood tests can detect signs of things like inflammations, allergies or metabolic changes.

Special allergy tests can be used to find out which substances cause redness or swelling when applied to the skin.

Ultrasound examinations provide exact information about how deep and thick skin changes are. They can also help determine how large a tumor is.

Skin sample (biopsy): In order to find out whether a skin change is a benign (non-cancerous) or malignant (cancerous) tumor, a small sample of skin is taken using a local anesthetic and then examined in a laboratory. Skin samples can also be used to help determine whether skin changes are signs of certain kinds of allergies, infectious diseases and autoimmune diseases.

Some fungal infections and other skin conditions can be seen with the help of a special lamp, known as a Wood’s lamp, which emits ultraviolet and violet light.