Skin Lesion Enquiry

Name*

First NameLast Name

Date of Birth*

Phone number

How long have you had this lesion? (enter a number)*

How long have you had this lesion? (choose one option)*

Whereabouts on your body is it?

Is it itchy?

yesno

Is it painful?

yesno

Is it spreading?

yesnonot sure

Do you have other skin lesions, if so does this one look different?

yesnonot applicable

Is it there all the time, or does it come and go?

same all the timecomes and goes

Did it come on

suddenly?gradually?not sure

Were there any triggers? If so, please describe:

Have you had anything similar before? If so, please describe:

What have you tried? eg creams, medications

What is your skin type?

always burns, never tans (palest; freckles)usually burns, tans minimallysometimes mild burn, tans uniformlyburns minimally, always tans well (moderate brown)very rarely burns, tans very easily (dark brown)never burns (deeply pigmented dark brown to darkest brown)

Have you been feeling unwell in yourself, eg fever, weight loss?

yesno

Do you have any relevant family history?

Do you have any particular concerns about this skin lesion?

Please read the following informationon how to take a photograph of your skin problem, then upload a photo

Before you start

· Check that your camera lens is clean. It’s fine to use a smartphone camera

· If practical find an assistant. It’s much better if someone else takes the photo

· Move to a bright area with lots of natural light. Ideally, don’t use artificial light or flash.

· Position your assistant so that they do not cast a shadow over the area being photographed

· Place the area to be photographed on a plain background (such as a plain towel or sheet) if possible

Taking the photo

· Ideally use the main camera on your phone not the front-facing selfie camera (unless you have to take your own photos)

· Take an orientation photo (further away – so we can see where it is and get the lesion in context) and also a close-up (so we get a good image of the lesion)

· When taking a close-up photo with a phone camera the optimum distance is about 10-12cm (4-5in). Don’t get too close as otherwise focus will be lost. Try to avoid casting a shadow on the lesion.

· On most phones, if you touch the screen over where the lesion is it will focus on the area of interest

· Take lots of photos and check that the skin lesion is clearly visible and focussed, as if you were looking at it in real life. If not, try again

Sending the photo

· Only send the best orientation and the best close-up photos (1 of each).

· If given the option, reduce the picture size to between 1 and 2 Mb but no smaller.

Please upload a photo of the lesion

Browse Files

I give my consent for the photo to be stored in my medical record

YesNo