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Dermatology > Skin surgery and tumour management > Flashcards

Skin surgery and tumour management Flashcards

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Dermatology Board Prep flashcards
1
Q

Surgery is a practical skill which can only be learned under supervision. T/F

A

True

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2
Q

All specimens removed from the body surgically should be sent to pathology. T/F

A

True

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3
Q

What are the indications for skin biopsy?

A

Assistance in the diagnosis of unusual skin rashes or tumours, removal of suspected malignancy or removal of unwanted skin growth

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4
Q

How does a dermatofibroma present?

A

Round, pink, firm nodule often with increased pigmentation around the rim

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5
Q

How does a common melanocytic naevi present?

A

Presents in childhood/adolescence and gradually loses pigment over the years (usually has a regular border)

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6
Q

How does a basal cell papilloma present?

A

Stuck on lesion with the appearance of a cookie

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7
Q

How is bullous pemphigoid treated?

A

High dose steroids

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8
Q

Biopsy of a rash often does not provide diagnosis. T/F

A

True - many skin conditions appear similar histologically (e.g different types of eczema) OR one cause of a skin condition may have many different histological patterns (e.g drug eruption)

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9
Q

Biopsy of a skin tumour requires clinical diagnosis beforehand. T/F

A

True

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10
Q

What decides the best treatment option of a skin tumour? What are the various options?

A

The diagnosis. Surgery, photodynamic therapy, cryotherapy , chemo/radiotherapy, 5-flurouracil (topical chemo), solaraze (diclofenac), imiquimod (immune response modulator)

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11
Q

How is non-melanoma skin cancer treated?

A

Surgically, photodynamic therapy (superficial BCC), imiquimod cream (BCC),

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12
Q

How may common pre-cancers be treated?

A

Cryotherapy, solaraze, 5-FU, PDT, imiquimod, skin resurfacing

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13
Q

What factors are essential to know about before operating?

A

PMH, drug history, bleeding disorders, allergies, implanted devices (e.g pacemaker)

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14
Q

Steroids slow wound healing and increase infection risk. T/F

A

True

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15
Q

Smoking slows wound healing and often causes the rejection of skin grafts. T/F

A

True

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16
Q

How is melanoma treated?

A

Surgically with/without chemo/radiotherapy (chemo isn’t particularly useful)

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17
Q

What are the five layers of the scalp?

A

Skin Connective tissue Aponeurosis Loose connective tissue Periosteum

18
Q

What are the three divisions of the trigeminal nerve?

A

CNV = CNV1 (ophthalmic), CNV2 (maxillary), CNV3 (mandibular)

19
Q

How might injuries to the face cause damage to the maxillary division of the trigeminal nerve?

A

Damage to the foramen in the maxilla which transmits the nerve

20
Q

How are the three divisions of the trigeminal nerve tested for sensation loss?

A

By gently brushing a cotton wool bud over the three dermatomes and asking the patient to report back any sensation (patients eyes should be closed during the procedure)

21
Q

How might injuries to the face cause damage to the mandibular division of the trigeminal nerve?

A

Fractures to the mandibular body or ramus may cause numbness of the chin and/or lower lip (as the nerve runs along these areas)

22
Q

The trigeminal nerve gives sensory/motor supply to the face

A

Sensory (motor to the muscles of mastication)

23
Q

The facial nerve (CN VII) gives sensory/motor supply to the face

A

Motor to the muscles of facial expression (sensory function - taste)

24
Q

Where do wrinkles form?

A

At a 90 degree angle to muscle fibre direction

25
Q

How is the facial nerve tested clinically? Which muscles are being tested?

A

By asking the patient to frown and to close their eyes tightly. Frontalis, orbiticularis oculi, orbiticularis oris

26
Q

What are the methods of local anaesthesia?

A

Topical, local invasion, nerve block and field block

27
Q

What are the types of local anaesthetic?

A

Lidocaine with/without adrenaline

28
Q

When is lidocaine excretion reduced?

A

In those with liver, renal or cardiac failure and in the young and elderly

29
Q

What is the benefit of an anaesthesia with adrenaline?

A

Prolongs effect and reduces bleeding

30
Q

When should anaesthesia with adrenaline be avoided?

A

In the fingers and toes, or in patients with cardiac disease or on psychotropic drugs

31
Q

How can local anaesthetic be made less painful?

A

Relaxing the patient, use a fine needle, warm the area to be numbed, omit adrenaline, massage skin, inject slowly

32
Q

What are the possible complications of skin biopsy?

A

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

33
Q

What are the basic methods of skin surgery? What are some other methods of skin surgery?

A

Electrosurgery, snip excision, curettage, shave excision, punch biopsy, elliptical excision. Photodynamic therapy, laser, dermabrasion, plastic surgery, Mohs micrograph surgery

34
Q

What is electrosurgery?

A

A variety of electrosurgery units which are used for haemostasis and so the treatment of minor skin lesions (e.g skin tags)

35
Q

What is a snip excision?

A

The lesion is cut across the base

36
Q

What is curettage?

A

Removal of skin lesion via a round scalpel

37
Q

What are the benefits and disadvantages of curettage?

A

It is minimally invasive but pathology specimen does not accurately record the margins of the tumour

38
Q

What is a shave excision?

A

A needle is stuck through a skin lesion and a scalpel is used to cut it off

39
Q

What is a punch biopsy?

A

A sample of a lesion is taken using a circular scalpel device

40
Q

What are the benefits and disadvantages of punch biopsy?

A

It is quick and produces a good wound edge but it can be difficult to judge depth, round holes do not always heal well and may not give a large enough tissue sample

41
Q

What is the most widely used surgery for the removal of small skin lesions?

A

Elliptical biopsy

Dermatology (26 decks)

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