Skin Examination Consent (Female) · Dr. Blinkhorn & Dr. Whiting Family Practice

Why This Examination Matters

A complete skin examination is one of the most effective ways to detect skin cancer early, when it is most treatable. Melanoma and other skin cancers can appear anywhere on your body, including areas not typically exposed to the sun.

Even with dermoscopy (a special magnifying instrument), this examination cannot detect every skin cancer. You should report any new, changing, bleeding, or non-healing lesion to your physician promptly.

What to Expect

The examination typically takes 10–15 minutes
Your doctor will examine your skin systematically from head to toe
A dermoscope may be used to look more closely at any concerning spots
You will be asked to change positions to examine different body areas
Your privacy and comfort will be maintained throughout

Your Comfort and Preferences

Your comfort and dignity are important to us. Please indicate your preferences below. You may withdraw or modify your consent at any time without affecting your care.

Preference 1

Buttocks and Lower Abdomen

Melanoma can occur in these areas. If underwear is kept on, the physician will need to briefly adjust the fabric to view the skin underneath.

I give permission to adjust my underwear as needed to examine these areas. Please omit this area from today’s examination.

Preference 2

Inner Thigh

Examining the inner thigh requires adjusting the position of your legs.

I consent to examination of the inner thigh. Please omit the inner thigh — proceed directly to the lower legs and feet.

Preference 3

Bra and Breast Area

The back, chest, and underneath the breasts are areas where skin cancers can occur. You will be given a gown to wear. To examine the full chest and back, you will need to remove your bra.

I am comfortable removing my bra for the examination. Please omit the breast area from today’s examination.

Your Details

Full Name *

Date of Birth *

Health Card Number (CPN) *

After Your Examination

Your doctor will discuss any findings with you and provide recommendations for follow-up care if needed. Most skin changes are benign, but early detection of any problems leads to the best outcomes.

References

Canadian Cancer Society. Skin cancer statistics. Available from: cancer.ca
Dinnes J, Deeks JJ, Chuchu N, et al. Dermoscopy, with and without visual inspection, for diagnosing melanoma in adults. Cochrane Database Syst Rev. 2018;12(12):CD011902.
Canadian Dermatology Association. Melanoma prevention and detection. Available from: dermatology.ca

This form is for informational and consent purposes and does not replace personalized medical advice from your healthcare provider.

Skin Examination Consent and Preferences

Buttocks and Lower Abdomen

Inner Thigh

Bra and Breast Area