Management of Skin TUmours

Question 1

what do dermatofibromas look like and are they removed?

Answer 1

firm nodule
pigmented edge
not removed

Question 2

what lesions are left alone?

Answer 2

dermatofibromas

basal cell papilloma

Question 3

are bullous pemphigoid blisters biopsied?

Answer 3

yes

helpful to confirm diagnosis by showing fluid between layers

Question 4

when is a rash biopsied?

Answer 4

to look for a diagnosis
however different things can look the same or the same thing can look different (i.e drug eruption can cause diff symptoms)

Question 5

topical cancer treatment?

Answer 5

imiquimod cream (often only used if patient denies surgery)

Question 6

precancer lesions treatments?

Answer 6

cryotherapy
solaraze
5 FU
PDT
resurfacing
imiquimod

Question 7

what is done for melanoma?

Answer 7

excision biopsy
- KEY TERM
further surgery, radio/chemo therapy if needed (mets etc)

Question 8

how can steroids affect surgery?

Answer 8

increased infection risk
poor wound healing
can affect diabetes

Question 9

affect of aspirin in surgery?

Answer 9

bleeding risk

Question 10

how does smoking affect surgery?

Answer 10

poor wound healing

Question 11

3 bad areas for surgery (Tiger Areas)?

Answer 11

temple - superficial temple artery
front of ear - facial nerve
side of neck - nerve fibres can inhibit shoulder movement

Question 12

injury to face causing patch of numbness in middle of cheek, what is damaged?

Answer 12

maxillary division of trigeminal nerve

Question 13

sudden loss of movement of half of face, what is damaged?

Answer 13

facial nerve

Question 14

types of local anaesthetic?

Answer 14

topical - good superficially but not great
subcutaneous injection (below dermis)
nerve block
field block

Question 15

what is the most common anaesthetic?

Answer 15

lignocaine (amide)

used with adrenaline

Question 16

when is lignocaine not as safe?

Answer 16

liver, renal, cardiac failure
young
elderly

Question 17

what does adrenaline do with anaesthetic?

Answer 17

prolongs anaesthesia and reduces bleeding

Question 18

methods of skin surgery?

Answer 18

electrosurgery
snip
curettage
shave
punch
elliptical

Question 19

what is electrosurgery used for?

Answer 19

mino lesions or tags

good at haemostasis

Question 20

what is curettage and cautery?

Answer 20

scraping off and cauterising the base wound

doesn’t accurately record margins of tumour

Question 21

shave excision?

Answer 21

flat specimen shaved off using scalpel

Question 22

punch?

Answer 22

quick and gives good wound edges but sample can be too small and difficult to judge depth

Question 23

which surgical method is used for expected melanoma?

Answer 23

elliptical excision with 2-4 mm margin

Question 24

how are tension lines used in surgery?

Answer 24

incisions run parallel with tension lines

Question 25

methods of repairing skin surgery wound?

Answer 25

close two edges of wound together skin graft skin flap (better result than graft as local skin used)

Question 26

how is sentinel node found?

Answer 26

dye injected into site of melanoma and then the draining lymph node will absorb the colour

Question 27

how is sentinel node found?

Answer 27

dye injected into site of melanoma and then the draining lymph node will absorb the colour

Question 28

are all specimens always sent to pathology?

Answer 28

yes