Step-by-Step OSCE Guide

GETTING STARTED

1. Perform hand hygiene and don PPE if required.
2. Introduce yourself: “Hi, I’m Jamie, one of the advanced clinical practitioners.”
3. Confirm the patient’s full name and date of birth.
4. Explain the exam: “I’d like to take a closer look at a skin lesion you’ve got. I’ll examine its shape, colour, and texture.”
5. Explain the need for a chaperone if the lesion is in an intimate area.
6. Gain verbal consent and ensure appropriate exposure for a clear view.
7. Ask if the lesion is painful, itchy, or has changed recently.

GENERAL INSPECTION

8. Observe the number, size, and distribution of any pigmented lesions.
9. Note any dressings, creams, or monitoring devices that may provide diagnostic clues.

CLOSE INSPECTION – ABCDE ASSESSMENT

10. A – Asymmetry: Is one half unlike the other?
11. B – Border: Are the edges irregular, notched or blurred?
12. C – Colour: Is the colour uneven with multiple shades (brown, black, red, white or blue)?
13. D – Diameter: Is it larger than 6 mm? (about the size of a pencil end).
14. E – Evolution: Ask the patient if it has changed in size, shape, colour, or if it has bled, crusted or become itchy.

PALPATION

15. Gently palpate the lesion to assess:
    – Texture (raised, smooth, rough, nodular)
    – Tenderness or induration (firmness)
    – Fixation to underlying structures (mobility)
16. If suspicious, palpate regional lymph nodes (e.g. cervical, axillary, or inguinal depending on lesion site).

TO COMPLETE THE EXAM

17. Let the patient know the examination is complete and thank them.
18. Offer privacy to redress if needed.
19. Dispose of PPE and wash your hands.
20. Summarise your findings clearly.
21. Suggest further assessments:
    – Dermatoscopic examination
    – Digital monitoring or photography
    – Referral to dermatology or 2WW skin cancer pathway
    – Consider biopsy for histological diagnosis

Melanoma is rare but serious. The ABCDE approach helps spot red flags early. Always look for the “Ugly Duckling”, document findings clearly and take photos if permitted.