Biopsy-Blake Flashcards
What are the 3 different kinds of skin biopsies?
punch biopsy
shave biopsy
excision biopsy
What are some things that you need to do a biopsy (prep materials)?
cleaner (usu alcohol-could be iodine, chlorohexidine) band aid instruments gloves anesthetic (local, usu lidocaine)
What do you do with the skin biopsy sample?
put it in a formalin bottle
need to include 2 identifying factors
send with clinical information-like location, symptoms
Describe a punch biopsy.
use an instrument that is the size of a pencil, vary by diameter of biopsy needed.
has a hollow core
you roll the instrument back & forth & it takes out the core.
you can also vary the depth
T/F WIth a 1-2 mm diameter punch biopsy, you need stitches.
False.
Can use silver nitrate to stop the bleeding.
Also use pressure.
Why is lidocaine with epi helpful?
This is an anesthetic that helps to prevent bleeding. It is a constrictor.
T/F Punch biopsy does not require anesthetic.
false. you need it!
Possible exception: gangrene, b/c the tissue is already dead & no longer innervated.
What is the downside of a big round core biopsy of the skin?
there is a big hole
round things can’t be zippered together, can get dog ears.
if you go full thickness-will def get a scar.
What are the advantages of a punch biopsy?
can vary the depth of the biopsy, but can get flu thickness
if a small lesion (1-3mm), can just get rid of it by excision!!
good for representative sample (if you have a large rash).
If you have a huge rash…where do you usu grab the sample from?
the margin.
What are the disadvantages of a punch biopsy?
usu not excisional (if greater than 3 mm)
scar potential
if large sample taken, hard to close.
What does a shave biopsy of the skin entail?
a blade (normal blade or scalpel) need to make sure you get tissue going down & coming up
What are the advantages to a shave biopsy?
works great with raised lesions when local anesthetic is injected below--the skin is pushed up & made easier to shave quick less scarring potential versatile (in how deep & wide)
What are the disadvantages of a shave biopsy?
not full thickness
if it is melanoma–destroy the architecture & harder to evaluate
if it is not shallow-this biopsy is NOT curative
What is involved in an excisional biopsy?
involves a scalpel
come out with an ellipse-that is easily sown together
you can also get all the pieces of a sample-good if you are worried about malignancy
go 1/3 bigger on each side than lesion.
What are the advantages to excisional biopsies?
for many lesions-curative
clean margins
pathologist can see everything with preserved architecture
What are the disadvantages of an excisional biopsy?
takes longer
have a scar
more invasion–higher risk of infection & bleeding.
What is involved in a fine needle aspirate?
this is something that uses suction to gather cells.
can use to pull out endometrium from the uterus.
by nature–you lose architecture, but can look for neoplastic cells
What things must be observed for billing?
the width of the ellipse–look at its excisional diameter
also note the location
Which tend to bleed more–noncancerous or cancerous?
cancerous, usu
WHat are some ways to destroy lesions?
liquid nitrogen petrochemicals-hydrocarbons that get cold electrocautery lasers pharmacologic methods
What is involved in cryo?
use a gun
precision
but don’t want to use next to sensitive areas.
need to expand the area of the cotton ball
use 2 freeze-thaw cycles
When does the wart feel the damage of the cryo technique?
while it is thawing
the troops in Napoleon’s army that thawed out their legs constantly had more amputations than those that left their legs frozen throughout the winter.
How does billing for cryo work?
1-14 lesions cost the same amount.
