Section 03 of 09
What to ask
History-taking for skin lesions does not need to be lengthy, but it does need to be systematic. A few focused questions give you information that the dermatoscope cannot.
The lesion story
Start with the lesion itself. Four questions cover the essential ground:
How long has it been there? A lesion that has been present and unchanged for years is less concerning than one that appeared recently. But be cautious — patients often underestimate how long a lesion has been present, and "it has always been there" may mean "I first noticed it recently."
Has it changed? This is the single most valuable question. Change in size, shape, colour, elevation, or surface texture is significant. Ask specifically: "Has it grown? Changed colour? Started doing anything new?"
Does it do anything? Bleeding, crusting, itching, or pain — any symptoms associated with the lesion are worth documenting. Spontaneous bleeding (without trauma) is particularly concerning.
Why are you here today? The patient's own concern is clinically meaningful. A patient who has been watching a lesion for months and finally decided to seek help is telling you something — even if they cannot articulate exactly what worried them.
The risk context
Beyond the lesion itself, you need enough background to assess the patient's overall risk profile. This does not require a full dermatological history — a brief, targeted set of questions is sufficient:
- Have you ever had a skin cancer or a lesion removed?
- Does anyone in your family have a history of skin cancer, particularly melanoma?
- Do you have a history of significant sun exposure or sunburn?
- Are you on any medications that suppress your immune system?
You do not need to complete a full risk assessment for every lesion. But you do need enough context to know whether this patient sits in a higher-risk category — because that changes how you interpret what you see.
What patients do not tell you
Some important information only emerges if you ask. Patients may not mention that they have had previous lesions removed ("it was years ago"), that they used sunbeds in their twenties ("everyone did"), or that they are on immunosuppressive therapy ("I did not think that was relevant"). Direct, specific questions draw this out.
Which of the following questions is MOST likely to reveal clinically important information that the patient might not volunteer?