The Intraoral and Extraoral Exam
Cutaneous Area

As in the general appraisal, the exposed skin of the head and neck should be examined for suspicious lesions. The skin of the neck and scalp can be examined while the clinician is palpating the occipital and cervical nodes. The area behind and around the ear can be observed while palpating the auricular nodes. The patient should be questioned about their knowledge of any lesions discovered during the examination and also any lesions that they may have noticed themselves anywhere on the body. Information about the history, and any symptoms such as pain, pruritus (itching) or other abnormal sensations associated with the lesions is crucial in determining a differential diagnosis and can assist in deciding whether to refer to a specialist. The size and physical characteristics of suspicious nevi should be documented. These and other lesions exhibiting the warning signs associated with the ABCDE’s of Malignant Skin Lesions should be referred for further evaluation. In addition, the patient should be advised to watch for changes in nevi and other pigmented lesions not exhibiting the warning signs of skin cancer. Any evidence of physical abuse should be noted. This is especially relevant in the case of children who may not voice any problems. Subsequently, correlation between cutaneous lesions and intraoral lesions found during the intraoral examination should be made as in the case of the patient with discoid lupus erythematosus shown in Figures 6 and 7. The cutaneous lesions of discoid lupus (Figure 6) presented concurrently with the gingival inflammation (Figure 7) seen during the oral examination.