Biopsy-Blake

Question 1

What are the 3 different kinds of skin biopsies?

Answer 1

punch biopsy
shave biopsy
excision biopsy

Question 2

What are some things that you need to do a biopsy (prep materials)?

Answer 2

cleaner (usu alcohol-could be iodine, chlorohexidine)
band aid
instruments
gloves 
anesthetic (local, usu lidocaine)

Question 3

What do you do with the skin biopsy sample?

Answer 3

put it in a formalin bottle
need to include 2 identifying factors
send with clinical information-like location, symptoms

Question 4

Describe a punch biopsy.

Answer 4

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

Question 5

T/F WIth a 1-2 mm diameter punch biopsy, you need stitches.

Answer 5

False.
Can use silver nitrate to stop the bleeding.
Also use pressure.

Question 6

Why is lidocaine with epi helpful?

Answer 6

This is an anesthetic that helps to prevent bleeding. It is a constrictor.

Question 7

T/F Punch biopsy does not require anesthetic.

Answer 7

false. you need it!

Possible exception: gangrene, b/c the tissue is already dead & no longer innervated.

Question 8

What is the downside of a big round core biopsy of the skin?

Answer 8

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.

Question 9

What are the advantages of a punch biopsy?

Answer 9

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).

Question 10

If you have a huge rash…where do you usu grab the sample from?

Answer 10

the margin.

Question 11

What are the disadvantages of a punch biopsy?

Answer 11

usu not excisional (if greater than 3 mm)
scar potential
if large sample taken, hard to close.

Question 12

What does a shave biopsy of the skin entail?

Answer 12

a blade (normal blade or scalpel)
need to make sure you get tissue going down & coming up

Question 13

What are the advantages to a shave biopsy?

Answer 13

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)

Question 14

What are the disadvantages of a shave biopsy?

Answer 14

not full thickness
if it is melanoma–destroy the architecture & harder to evaluate
if it is not shallow-this biopsy is NOT curative

Question 15

What is involved in an excisional biopsy?

Answer 15

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.

Question 16

What are the advantages to excisional biopsies?

Answer 16

for many lesions-curative
clean margins
pathologist can see everything with preserved architecture

Question 17

What are the disadvantages of an excisional biopsy?

Answer 17

takes longer
have a scar
more invasion–higher risk of infection & bleeding.

Question 18

What is involved in a fine needle aspirate?

Answer 18

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

Question 19

What things must be observed for billing?

Answer 19

the width of the ellipse–look at its excisional diameter

also note the location

Question 20

Which tend to bleed more–noncancerous or cancerous?

Answer 20

cancerous, usu

Question 21

WHat are some ways to destroy lesions?

Answer 21

liquid nitrogen
petrochemicals-hydrocarbons that get cold
electrocautery
lasers
pharmacologic methods

Question 22

What is involved in cryo?

Answer 22

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

Question 23

When does the wart feel the damage of the cryo technique?

Answer 23

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.

Question 24

How does billing for cryo work?

Answer 24

1-14 lesions cost the same amount.