Skin surgery and tumour management Flashcards
Surgery is a practical skill which can only be learned under supervision. T/F
True
All specimens removed from the body surgically should be sent to pathology. T/F
True
What are the indications for skin biopsy?
Assistance in the diagnosis of unusual skin rashes or tumours, removal of suspected malignancy or removal of unwanted skin growth
How does a dermatofibroma present?
Round, pink, firm nodule often with increased pigmentation around the rim
How does a common melanocytic naevi present?
Presents in childhood/adolescence and gradually loses pigment over the years (usually has a regular border)
How does a basal cell papilloma present?
Stuck on lesion with the appearance of a cookie
How is bullous pemphigoid treated?
High dose steroids
Biopsy of a rash often does not provide diagnosis. T/F
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)
Biopsy of a skin tumour requires clinical diagnosis beforehand. T/F
True
What decides the best treatment option of a skin tumour? What are the various options?
The diagnosis. Surgery, photodynamic therapy, cryotherapy , chemo/radiotherapy, 5-flurouracil (topical chemo), solaraze (diclofenac), imiquimod (immune response modulator)
How is non-melanoma skin cancer treated?
Surgically, photodynamic therapy (superficial BCC), imiquimod cream (BCC),
How may common pre-cancers be treated?
Cryotherapy, solaraze, 5-FU, PDT, imiquimod, skin resurfacing
What factors are essential to know about before operating?
PMH, drug history, bleeding disorders, allergies, implanted devices (e.g pacemaker)
Steroids slow wound healing and increase infection risk. T/F
True
Smoking slows wound healing and often causes the rejection of skin grafts. T/F
True
How is melanoma treated?
Surgically with/without chemo/radiotherapy (chemo isn’t particularly useful)
What are the five layers of the scalp?
Skin Connective tissue Aponeurosis Loose connective tissue Periosteum
What are the three divisions of the trigeminal nerve?
CNV = CNV1 (ophthalmic), CNV2 (maxillary), CNV3 (mandibular)
How might injuries to the face cause damage to the maxillary division of the trigeminal nerve?
Damage to the foramen in the maxilla which transmits the nerve
How are the three divisions of the trigeminal nerve tested for sensation loss?
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)
How might injuries to the face cause damage to the mandibular division of the trigeminal nerve?
Fractures to the mandibular body or ramus may cause numbness of the chin and/or lower lip (as the nerve runs along these areas)
The trigeminal nerve gives sensory/motor supply to the face
Sensory (motor to the muscles of mastication)
The facial nerve (CN VII) gives sensory/motor supply to the face
Motor to the muscles of facial expression (sensory function - taste)
Where do wrinkles form?
At a 90 degree angle to muscle fibre direction
How is the facial nerve tested clinically? Which muscles are being tested?
By asking the patient to frown and to close their eyes tightly. Frontalis, orbiticularis oculi, orbiticularis oris
What are the methods of local anaesthesia?
Topical, local invasion, nerve block and field block
What are the types of local anaesthetic?
Lidocaine with/without adrenaline
When is lidocaine excretion reduced?
In those with liver, renal or cardiac failure and in the young and elderly
What is the benefit of an anaesthesia with adrenaline?
Prolongs effect and reduces bleeding
When should anaesthesia with adrenaline be avoided?
In the fingers and toes, or in patients with cardiac disease or on psychotropic drugs
How can local anaesthetic be made less painful?
Relaxing the patient, use a fine needle, warm the area to be numbed, omit adrenaline, massage skin, inject slowly
What are the possible complications of skin biopsy?
Bleeding, wound dehiscence, infection, scarring, motor/sensory nerve damage or loss of function
What are the basic methods of skin surgery? What are some other methods of skin surgery?
Electrosurgery, snip excision, curettage, shave excision, punch biopsy, elliptical excision. Photodynamic therapy, laser, dermabrasion, plastic surgery, Mohs micrograph surgery
What is electrosurgery?
A variety of electrosurgery units which are used for haemostasis and so the treatment of minor skin lesions (e.g skin tags)
What is a snip excision?
The lesion is cut across the base
What is curettage?
Removal of skin lesion via a round scalpel
What are the benefits and disadvantages of curettage?
It is minimally invasive but pathology specimen does not accurately record the margins of the tumour
What is a shave excision?
A needle is stuck through a skin lesion and a scalpel is used to cut it off
What is a punch biopsy?
A sample of a lesion is taken using a circular scalpel device
What are the benefits and disadvantages of punch biopsy?
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
What is the most widely used surgery for the removal of small skin lesions?
Elliptical biopsy
