Skin Cancer Surgical Management

Question 1

what are the different types of local anaesthesia

Answer 1

topical, local infiltration, nerve block, field block

Question 2

what type of anaesthetic is lignocaine(lidocaine) and what diseases affect it

Answer 2

amide type

excretion reduced in liver, renal, cardiac failure, young and elderly

Question 3

what drug is given alongside lignocaine(lidocaine) and why

Answer 3

adrenaline, prolongs anaesthesia and reduces bleeding

avoid in fingers + toes, avoid in cardiac disease + psychotropic drugs

Question 4

give some examples of ways local anaesthesia injections can be made less painful

Answer 4

relax patient, fine needle, slow injection, subcutaneous injection

Question 5

what complications are associated with skin surgery

Answer 5

bleeding, wound dehiscence, infection, scarring, motor or sensory nerve damage, loss of function

Question 6

what are the basic skin surgery methods

Answer 6

electrosurgery, snip excision, curettage, shave excision, punch biopsy, elliptical excision

Question 7

what is electrosurgery used for

Answer 7

haemostasis and treatment of minor skin lesions (eg skin tags)

Question 8

describe how snip excision is carried out

Answer 8

lesion grasped with skin hook, then cut across base of lesion to remove it

Question 9

describe what curettage and cautery is

Answer 9

type of electrosurgery in which skin lesion is scraped off and heat is applied to skin surface, wound is left to granulate
minimally invasive procedure

Question 10

describe the characteristics of a punch biopsy

Answer 10

quick, produces good wound edges

BUT difficult to judge edge, round holes don’t always heal well, sample may be too small

Question 11

describe the setup for an elliptical excision of a skin tumour

Answer 11

make sure relaxed skin tension lines either side of excision

have 30 degree angle at either side(rugby ball type shape)

Question 12

describe the cut used in elliptical excision, and what should be avoided

Answer 12

scalpel blade cuts at 90 degrees to skin surface giving wound vertical edges
should avoid fishtailing, ie crossing over cut at each side of oval

Question 13

what is the next step after the skin cuts are made in a elliptical excision

Answer 13

base is then cut through with scissors and pull ellipse out gently with skin hooks
skin then pulled from each side and stitched up

Question 14

what is the standard method of removal of most small skin lesions

Answer 14

elliptical excision

Question 15

what different forms of skin surgery are there, that aren’t usually used

Answer 15

laser, dermabrasion, plastic surgery(flaps, grafts), Mohs micrographic surgery