17 - Derm Surgery Flashcards
Incisional vs excisional removal?
Incisional - only a portion of the tumor is removed
Excisional - entire tumor is removed
Pic on slide 7
Biopsy techniques?
Shave biopsy
Punch biopsy
Excisional biopsy
Local anesthesia agents?
Lidocaine
- rapid onset 2 min
- duration 60-120 min
Bipivicane (marcaine)
- slow onset 5 min
- duration 4-8 hrs
Epinephrine
- vasoconstriction
- prolongs anesthesia
- dont use on anything with a tip
Surgical instruiments
Scalpels
Needle drivers
Skin hooks
Sutures
Slid 11-15 has pics
Purpose of shave biopsy?
- Obtain tissue for diagnostic purposes
- Remove benign surface neoplasms
Use for raised lesions when full thickness tissue specimen is not necissary
Shave techniques?
Mark lesion prior to anesthesia
Inject/infiltrate anesthetic
Hold traction and shave
Pics 23-24
Contraindications for shaving?
Suspicion of melanoma
- doesnt do full thickness
- need to determine thickness of tumor (breslow) and degree of invasiveness (clark level)
Advantages of shave biopsy?
- Rapid
- no sutures
- no assistant needed
- clean procedure (not sterile)
- easy
- simple wound care (RTD)
Disadvantages of shave biopsy?
Hypopigmentation +/- scar
Depressed scar may result
Not full thickness (diagnosis)
Complications of shave biopsy?
- Scar (indented/hypertrophic)
- Hypopigmentation
- Erythema
- Regrowth of incompletely removed lesion
- Infection (rare)
Uses for punch biopsy?
For full thickness specimen
Superficial inflammatory and bullous diseases
Tumors: Benign and malignant
Dont use punch biopsy for?
MM
Size range of punch biopsy?
2-8mm
2-3mm for face and small lesions
Larger usually require 1+ stitch
Punch technique?
Anesthestic
- wait 10 min
Pull tension on skin
Penetrate completely -> dermis exposing subQ fat
Pics 29-31
Punch contraindications?
Certain anatomical locations
- arteries and nerves esp
- hand dorsum
- face
- volar wrist
Advantages of punch biopsy
Full thickness specimen Better cosmesis Faster healing Easy to use, convenient Cheap
Disadvantages of punch biopsy
Hyptertrophic scar
Suture removal
Complications of punch biopsy?
Induration Erythema Hypertrophic scar Excessive protruding at skin edges (dog ears) Bleeding (rare) Infection (rare)
Indications for excisional biopsy?
Deep inflammatory disease - erythema nodosum MM Deep or nodular lesions - BCC, SCC
Preoperative evaluation for excisional biopsy
Allergies to meds Screen for bleeding tendencies ETOH/Tobacco HIV/hepatitis Abnormal scarring
When planning biopsy you should look at?
Skin tension lines
Natural wrinkle lines
- incision parallel or w/in the lines
Biopsy should include 2mm of margin of normal skin
Size/shape of biopsy technique?
Draw ellipse
Length = 3x width
Pics on 43-45
How to avoid “dog ears”?
Ends of ellipse 30%
Depth of excisional biopsy
Cut to depth of subQ fat
Then elevate it and snip w scissors/blade
Suture technique for excisional biopsy?
Get sub Q to decrease tension
1nd layer is cuticular sutures
Postoperative wound care
53-56 seems pretty intuitive
Suture choice and removal chart?
Slide 57
I went to a turtle’s party last night
I had a shell of a time
Guess what…
You know enough now to pass PA school
