Skin Exam & Dermatology Procedures Flashcards
Goals of a Skin Exam
Determine general skin color & number of nevi
Screen for melanoma
ABC’s of Screening for Melanoma
A: asymmetry B: border irregularities C: color variation D: diameter E: enlargement & evolution
Indications to Perform a Biopsy
All suspected neoplasms
All bullous disorders
Clarify a diagnosis when a limited number of entities are under consideration
Things to Known Before a Biopsy
Ask about allergies/reactions to topical antibiotics, local anesthetics, & tape
Know if a bleeding disorder, on aspirin or on warfarin
Biopsy Danger Zones
Areas overlying highly vascular structures
Areas associated with exit points of superficial nerves
Site Selection for Inflammatory Lesions
Biopsy those with characteristic inflammatory changes first
Site Selection for Blistering disease
Biopsy only newest vesicles or blisters
Remove vesicle intact with adjacent normal skin
Site Selection for Nonbullous Lesions
Maximal lesions skin & minimal normal skin
1-4 mm excise completely
Larger lesions: bx the edge, thickest portion or area that is most abnormal color
Site Selection for Bullae
Edge including small part of blister with adjacent intact skin
Considerations of Biopsies
Leave scars
Avoid cosmetic areas & areas with poor healing
Cosmetic areas: refer to derm or plastic surgeon
Anesthetic Used for Dermatology Procedures
Lidocaine 1%
Lidacaine 1% with epinephrine
Lidocaine 2.5% + Prilocaine 2.5%
Lidocaine 1%
Procedures including fingers, toes, nose, penis, or ear
May need to increase the pH
Lidocaine 1% with Epinephrine
NOT for procedures of the fingers, toes, nose, penis, or earlobes; or patients on non-selective beta blockers
Advantages of Epinephrine
Less bleeding
Prolongs anesthetic action
Allows larger volumes of anesthetic to be used safely
Local Anesthesia
Watch total dose administered
Insert needle through area just anesthetized
Lightly test skin or wound margins for adequate anesthesia
Field Block
For heavily contaminated wounds or when anesthetizing for I&D of a skin abscess
In a diamond formation
Langer’s Lines
Pull wounds open in the direction of skin tension lines
Parallel the direction of the collagen n the dermis
Shave Biopsy
Small, depressed scar
Lesions Suitable for Shave Biopsies
Elevated & confined to the epidermis
Seborrheic or actinic keratoses
Skin tags
Small superficial lesions
Punch Biopsies
Special tool in different sizes
Inject anesthetic
Stabilize skin with the thumb & forefinger
Excisional Biopsy
Draw ellipse around lesion
Length 3x the width
Grab edge of area to be excised; dissect biopsy tissue
Undermine edges of the wound
Closing an Excisional Biopsy
Interrupted non absorbable sutures
Needle points defined: cutting, tapered, blunt
Needles FS
For skin
Thick skin
Needles CE
Cutting needles
Thick skin
