Skin surgery & tumour management

Question 1

Which skin specimens should be sent to pathology?

Answer 1

All of them

Question 2

What are the indications for skin biopsy for rashes and tumours?

Answer 2

Rashes - assist diagnosis

Tumours - assist diagnosis, remove cancer, cosmetics

Question 3

What are the features of dermatofibroma?

Answer 3

Firm, increased pigment around rim

Question 4

How does melanocytic naevi present?

Answer 4

Macule with a regular border, acquired during childhood/adolescence, depigmentation over years

Question 5

What is the appearance of a basal cell papilloma?

Answer 5

Stuck on, cookie like

Question 6

What is the system for looking at a malignant melanoma?

Answer 6

A - asymmetry
B - border 
C - colour
D - diameter 
E - evolution

Question 7

How would you describe the blisters in bullous pemphigoid?

Answer 7

Large and tense

Question 8

What are the limitations of skin biopsy in regard to rashes?

Answer 8

Many different skin conditions have the same histology (i.e different types of eczema)
One cause of a particular skin condition can have many different histology patterns (i.e drug eruption)

Question 9

How can we treat a superficial basal cell carcinoma?

Answer 9

Photodynamic therapy

Topical chemotherapy

Question 10

How might we treat pre-cancers?

Answer 10

Cryotherapy
Solaraze (NSAID)
5-FU (fluorouracil)
Photodynamic therapy
Imiquimod 
Resurfacing

Question 11

Why would a patient on steroids warrant special care for skin surgery?

Answer 11

Reduced wound healing

Immunosupression

Question 12

Why might a smoker warrant special care for skin surgery?

Answer 12

Smoking is associated with poor wound healing and graft rejection

Question 13

How do we treat malignant melanoma skin cancer?

Answer 13

Surgery
Radiotherapy
Chemotherapy often useless

Question 14

Which nerve supplies the muscles of mastication?

Answer 14

Trigeminal

Question 15

Which nerve supplies the muscles of facial expression?

Answer 15

Facial

Question 16

Which nerve may be damaged in an (angle of) mandible fracture?

Answer 16

Mandibular branch of the trigeminal

Question 17

Which nerve may be damaged in a zygoma fracture?

Answer 17

Maxillary branch of trigeminal (transmitted through the inferior optic foramen)

Question 18

Name three muscles of facial expression

Answer 18

Frontalis, orbicularis oculi, orbicularis oris

Question 19

Name the methods of local anaesthesia

Answer 19

Topical
Local
Nerve block
Field block

Question 20

Name a local anaesthetic

Answer 20

Lignocaine

Question 21

Why is adrenaline useful in a local anaesthetic?

Answer 21

Reduces bleeding and prolongs affect of anaesthetic

Question 22

When should adrenaline be avoided in local anaesthetic?

Answer 22

End arteries (nasal cartilage, fingers, toes)

Question 23

What are some complications of skin biopsy?

Answer 23

Bleeding
Wound dehiscence 
Nerve damage
Loss of function
Infection
Scarring

Question 24

When is electrosurgery used?

Answer 24

Haemostasis

Minor skin lesions (e.g tags)

Question 25

When is a snip excision used?

Answer 25

Bulbous lesions which can be easily cut at the base

Question 26

When is curettage used?

Answer 26

When the aim is for a minimally invasive procedure

Question 27

When is shave excision used?

Answer 27

Small lesions that can be easily cut off

Question 28

What are the positives of using a punch biopsy?

Answer 28

Quick, clean wound

Question 29

What are the negatives of using a punch biopsy?

Answer 29

Round wounds do not heal well
Sample may be too small
Depth is hard to judge

Question 30

What is the typical method of removal used in small skin lesions?

Answer 30

Elliptical excision

Question 31

What types of surgery may be needed in larger lesions?

Answer 31

Grafts, flaps