Basal cell carcinoma physical examination: Difference between revisions

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{{Basal cell carcinoma}}
{{Basal cell carcinoma}}


{{CMG}}; {{AE}} {{JH}}
{{CMG}}; {{AE}}{{M.N}}


==Overview==
==Overview==
The physical examination of basal cell carcinoma is based on a clinical exam.  
[[Patients]] with basal cell carcinoma usually have normal general appearance. [[Skin]] [[examination]] usually show [[papules]], [[plaques]], [[central]] [[ulceration]] with rolled borders, [[telangiectasias]].


==Physical Examination==
==Physical Examination==
The physical examination of basal cell carcinoma is based on a clinical exam.
*[[Physical examination]] of [[patients]] with basal cell carcinoma is usually normal except some [[skin]] findings:


====Face====
===Appearance of the Patient===
*[[Patients]] with basal cell carcinoma are usually normal
 
===Vital Signs===
*[[Vital signs]] of [[patients]] with basal cell carcinoma are usually within normal limits
 
===Skin===
* [[Skin]] [[examination]] of [[patients]] with basal cell carcinoma usually varies like<ref name="CameronLee2019">{{cite journal|last1=Cameron|first1=Michael C.|last2=Lee|first2=Erica|last3=Hibler|first3=Brian P.|last4=Barker|first4=Christopher A.|last5=Mori|first5=Shoko|last6=Cordova|first6=Miguel|last7=Nehal|first7=Kishwer S.|last8=Rossi|first8=Anthony M.|title=Basal cell carcinoma|journal=Journal of the American Academy of Dermatology|volume=80|issue=2|year=2019|pages=303–317|issn=01909622|doi=10.1016/j.jaad.2018.03.060}}</ref><ref name="pmid25134314">{{cite journal |vauthors=Sehgal VN, Chatterjee K, Pandhi D, Khurana A |title=Basal cell carcinoma: pathophysiology |journal=Skinmed |volume=12 |issue=3 |pages=176–81 |date=2014 |pmid=25134314 |doi= |url=}}</ref>
**Waxy [[papules]] or [[plaques]]
**Crusting
**Rolled borders
**Central [[ulceration]]
**[[Telangiectasias]] over the surface
**Shiny and pearly
 
===HEENT===
*HEENT [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Neck===
*[[Neck]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal
 
===Lungs===
*[[Pulmonary examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Heart===
*[[Cardiovascular]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Abdomen===
*[[Abdominal examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Back===
*[[Back]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Genitourinary===
*[[Genitourinary]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Neuromuscular===
* [[Neuromuscular]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Extremities===
*[[Extremities]] [[examination]] of [[patients]] with basal cell carcinoma is usually normal.
 
===Image gallery===


<gallery>
<gallery>
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<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>


</gallery>
====Neck====
<gallery>
Image:Basal_cell_carcinoma _16.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
</gallery>
====Extremities====
<gallery>
Image:Basal_cell_carcinoma_31.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
</gallery>
====Perineal area====
<gallery>
Image:Basal_cell_carcinoma_36.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
</gallery>
====Skin====
<gallery>
Image:Basal_cell_carcinoma _06.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma _07.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma _08.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma _17.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma _18.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_23.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_25.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_26.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_27.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_28.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_30.jpeg|Basal cell carcinoma. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_39.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Image:Basal_cell_carcinoma_40.jpeg|Basal cell carcinoma.
<SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12  With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://atlasdermatologico.com.br/disease.jsf?diseaseId=52>
Physical examination of patients with [disease name] is usually normal.
OR
Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Appearance of the Patient
Patients with [disease name] usually appear [general appearance].
Vital Signs
High-grade / low-grade fever
Hypothermia / hyperthermia may be present
Tachycardia with regular pulse or (ir)regularly irregular pulse
Bradycardia with regular pulse or (ir)regularly irregular pulse
Tachypnea / bradypnea
Kussmal respirations may be present in _____ (advanced disease state)
Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
High/low blood pressure with normal pulse pressure / wide pulse pressure / narrow pulse pressure
Skin
Skin examination of patients with [disease name] is usually normal.
OR
Cyanosis
Jaundice
Pallor
Bruises
UploadedImage-01.jpg
Description (Adapted from Dermatology Atlas)
Description (Adapted from Dermatology Atlas)
HEENT
HEENT examination of patients with [disease name] is usually normal.
OR
Abnormalities of the head/hair may include ___
Evidence of trauma
Icteric sclera
Nystagmus
Extra-ocular movements may be abnormal
Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
Ophthalmoscopic exam may be abnormal with findings of ___
Hearing acuity may be reduced
Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
Exudate from the ear canal
Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
Inflamed nares / congested nares
Purulent exudate from the nares
Facial tenderness
Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
Neck examination of patients with [disease name] is usually normal.
OR
Jugular venous distension
Carotid bruits may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
Lymphadenopathy (describe location, size, tenderness, mobility, and symmetry)
Thyromegaly / thyroid nodules
Hepatojugular reflux
Lungs
Pulmonary examination of patients with [disease name] is usually normal.
OR
Asymmetric chest expansion OR decreased chest expansion
Lungs are hyporesonant OR hyperresonant
Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
Rhonchi
Vesicular breath sounds OR distant breath sounds
Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
Wheezing may be present
Egophony present/absent
Bronchophony present/absent
Normal/reduced tactile fremitus
Heart
Cardiovascular examination of patients with [disease name] is usually normal.
OR
Chest tenderness upon palpation
PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
Heave / thrill
Friction rub
S1
S2
S3
S4
Gallops
A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
Abdominal examination of patients with [disease name] is usually normal.
OR
Abdominal distension
Abdominal tenderness in the right/left upper/lower abdominal quadrant
Rebound tenderness (positive Blumberg sign)
A palpable abdominal mass in the right/left upper/lower abdominal quadrant
Guarding may be present
Hepatomegaly / splenomegaly / hepatosplenomegaly
Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
Back examination of patients with [disease name] is usually normal.
OR
Point tenderness over __ vertebrae (e.g. L3-L4)
Sacral edema
Costovertebral angle tenderness bilaterally/unilaterally
Buffalo hump
Genitourinary
Genitourinary examination of patients with [disease name] is usually normal.
OR
A pelvic/adnexal mass may be palpated
Inflamed mucosa
Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
Neuromuscular examination of patients with [disease name] is usually normal.
OR
Patient is usually oriented to persons, place, and time
Altered mental status
Glasgow coma scale is ___ / 15
Clonus may be present
Hyperreflexia / hyporeflexia / areflexia
Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
Muscle rigidity
Proximal/distal muscle weakness unilaterally/bilaterally
____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
Unilateral/bilateral upper/lower extremity weakness
Unilateral/bilateral sensory loss in the upper/lower extremity
Positive straight leg raise test
Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
Positive/negative Trendelenburg sign
Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
Normal finger-to-nose test / Dysmetria
Absent/present dysdiadochokinesia (palm tapping test)
Extremities
Extremities examination of patients with [disease name] is usually normal.
OR
Clubbing
Cyanosis
Pitting/non-pitting edema of the upper/lower extremities
Muscle atrophy
Fasciculations in the upper/lower extremity
</gallery>
</gallery>


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{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 14:57, 11 March 2019


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Maneesha Nandimandalam, M.B.B.S.[2]

Overview

Patients with basal cell carcinoma usually have normal general appearance. Skin examination usually show papules, plaques, central ulceration with rolled borders, telangiectasias.

Physical Examination

Appearance of the Patient

  • Patients with basal cell carcinoma are usually normal

Vital Signs

Skin

HEENT

Neck

Lungs

Heart

Abdomen

Back

Genitourinary

Neuromuscular

Extremities

Image gallery

References

  1. ↑ Cameron, Michael C.; Lee, Erica; Hibler, Brian P.; Barker, Christopher A.; Mori, Shoko; Cordova, Miguel; Nehal, Kishwer S.; Rossi, Anthony M. (2019). "Basal cell carcinoma". Journal of the American Academy of Dermatology. 80 (2): 303–317. doi:10.1016/j.jaad.2018.03.060. ISSN 0190-9622.
  2. ↑ Sehgal VN, Chatterjee K, Pandhi D, Khurana A (2014). "Basal cell carcinoma: pathophysiology". Skinmed. 12 (3): 176–81. PMID 25134314.

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