Derm procedures Flashcards
Describe liquid nitrogen
Destructively cold, clear liquid
-346 F
How is liquid nitrogen maintained?
Vacuum sealed container
- Must have pressure relief valve
- Delivered to facility, placed in large storage container, then transferred to smaller containers for daily use, refilled daily
Liquid nitrogen MOA
- Destroys tissue
- Causes inflammatory response
Process of liquid nitrogen treatment
Freeze - destroy tissue - causes separation - blister - scab - resolution once scab heals (hopefully)
Indications for liquid nitrogen
Warts Skin tags Seb keratoses Lentiginies Actinic keratoses Early BCC/SCC *DO NOT FREEZE IF IT NEEDS A BIOPSY
Which conditions should NOT be frozen with liquid nitrogen?
Anything that needs a biopsy
Downsides of liquid nitrogen treatment
- Hypopigmentation
- Depressed scarring
- Nerve damage
- Incomplete lesion resolution
- Painful
Procedure of liquid nitrogen
- Each spot frozen for approx 10 secs
- Freeze 1-2 mm beyond lesion
- Trigger hold (continuous vs. pulsing)
If liquid nitrogen tx is near the eye, what should be done?
Cover eye with gauze
Post liquid nitrogen expectations
- Area will blister within 12 hrs
- Blister will dry and for a scab in a few days
- Scab will persist 1-2 weeks
Post liquid nitrogen care
None needed - ok to wet, no bandage, no abx ointment
Where may swelling occur after liquid nitrogen treatment?
Inferior to treatment site (gravity)
Follow up for liquid nitrogen therapy
Depends on what you are treating - ALWAYS see pt back if AK/BCC/SCC
What is saucerization?
Deeper shave biopsy
Define shave biopsy/removal
Superficial removal/biopsy of a lesion
Is shave biopsy/removal a clean or sterile procedure?
CLEAN - wear gloves, prep with alcohol and local anesthetic
What instruments are used in shave biopsy/removal?
15 blade on a scalpel handle OR small handheld blade (Dermablade)
Shave biopsy/removal should include how much skin?
Include epidermis and uppermost dermis (no deeper than 1 mm)
What can be used for hemostasis after shave biopsy/removal?
Aluminum chloride or electrocautery
What should be done after taking the shave biopsy/removal?
Apply vaseline or bacitracin and band-aid
After care of shave biopsy/removal
- Start 24 hrs after procedure
- Perform daily x 5 days
- Wash w/soap and water
- Apply Vaseline or bacitracin
- Apply band-aid
- Review s/s of infection w/pt
- Let pt know when to expect biopsy results
Complications of shave biopsy/removal
- Infection
- Scarring
- Bleeding
- Nerve damage
- Incomplete removal
Define punch biopsy/excision
Method of obtaining a specimen at full thickness (all layers) using a punch instrument
Indications for punch biopsy
Diagnose lesions, eruptions, hair evaluations
Indications for punch excision
Nevi, cysts, dermatofibromas
Punch biopsy sizing
- Rash biopsy 4 mm
- Hair biopsy 4 mm
- Cyst removal 6-8 mm
Is punch biopsy a clean or sterile procedure?
Clean - wear gloves, cleanse area w/alcohol, use local anesthetic
How to remove punch biopsy/excision specimen?
Use needle to pierce it and then cut at bottom of specimen (do NOT use forceps because it may crush tissue making pathology reading difficult)
Why shouldn’t forceps be used in punch biopsy?
Crushes skin tissue causing difficulty for pathology reading
Post treatment of punch biopsy/removal
- Small punches (1.5-2 mm) can be left to heal by secondary intentino
- If larger, close wound by suturing (3 mm punch is 1 suture)
- Vaseline/bacitracin and a pressure dressing
