Procedural dermatology Flashcards
1
Q
Biopsies
A
- Considerations: anatomic site, type and size of lesion, desired histologic info, patient preference
- Shave biopsy (saucerization): Used to biopsy epidermal and superficial dermal processes, or large/elevated lesions (using local anesthesia)
- Punch biopsy: used to biopsy dermal processes, subcutaneous fat, rashes, desecrate lesions (requires desired size of punch, anesthetic)
- Incisional: biopsy large, deeper lesions (lesion remains in patient)
- Excisional: biopsy benign, sub-epidermal lesions, or malignant-appearing lesions
- Both incisional and excisional require surgery equipment
2
Q
Various treatments
A
- Intralesional injections (kenalog as ex) used on keloids, acne cysts, ect
- Cryosurgery: uses liquid N2 for local tissue destruction. Mostly for actinic keratosis, non-melanoma skin cancer, warts
- Cryosurgery post-Rx expectations: erythema, edema, blister formation w/in 24 hrs
- Acne surgery: intralesional kenalog injections for acne nodules, comedone extraction, chemical peels
- Acne scar Rx: kenalog injections, dermabrasion, laser, punch-grafting, soft tissue fillers, surgery
3
Q
-Lasers
A
- Light absorbed by chromophores (Hg, melanin, water)
- Selective photothermolysis: matching wavelength and pulse duration to obtain optimal effect on a targeted tissue w/ minimal effect on surrounding tissue
- Used on vascular lesions, pigmented lesions, hair removal, tattoo removal
- Considerations: desired target chromophore and corresponding wavelength, patients skin type
4
Q
Neuromodulators
A
- Botox (botulism toxin) used for many applications, particularly rhytids (wrinkles)
- Botox inhibits release of AcCh from presynaptic motor neurons to cause flaccid paralysis of rhytids
- Fillers are used to soften the appearance of wrinkles, fillers also used to Rx acne scars, for lip augmentation, and Rx of HIV lipoatrophy (filler most commonly used: hyaluronic acid)
- Hyperhidrosis: eccrine glands produce more sweat than normal
- Neuromodulators that inhibit AcCh release onto the gland (stimulatory NT) will inhibit sweat production
5
Q
Liposuction and fat transfers
A
- HIV lipodystrophy: redistribution of fat
- HIV lipoatrophy: selective loss of fat, can be of peripheral sites (face, limbs, heels, butt)
- HIV central lipohypertrophy: dorsecervial, supraclavicular, within breasts, intra-abdominal, visceral
- Metabolic abnormalities may occur
- Liposuction used to treat lipohypertrophy, fat transfers and fillers used for lipoatrophy
6
Q
Sclerotherapy
A
-Rx of telangiectasias and reticular veins using sclerosing agents
7
Q
Hair transplants
A
- Primarily used for androgenetic alopecia
- Consider patient selection and expectations
- Patient under local anesthesia, surgical team
8
Q
Electrodessication & curettage (ED&C)
A
- Physical destruction used for BCCs and low risk SCCs
- Comparable to excision
9
Q
Primary excision
A
- Used for benign and malignant lesions
- Designed as ellipse for proper margins and closure
- Use local anesthesia, surgical environment
10
Q
Mohs surgery
A
- Combines surgery with pathology for removing skin cancer
- Highest 5-year cure rate
- Uses in-surgery analysis of margins of tissue for preservation of non-cancerous tissue and removal of cancerous tissue
- Big reasons to do Mohs: recurrent cancers, high-risk locations, tissue preservation (digits, genitals), perineural invasion
- Cross-section the sample upon examination w/ microscope to identify margins still in need of excision
11
Q
Complex surgical repairs
A
- Flaps: moving local tissue to fill defect
- Types: advancement flaps (move along linear direction), rotation flaps (move along pivot point), transposition flaps (move over intact skin)
- Grafts: moving distant tissue
- Types: full thickness skin graft (contains adnexal structures), split thickness skin graft (epidermis and portion of dermis w/o adnexal structures), composite graft (skin + cartilage, fat, or perichondrium), free cartilage graft (cartilage to repair defects in nasal ala, ear)
