Skin surgery & tumour management Flashcards
Which skin specimens should be sent to pathology?
All of them
What are the indications for skin biopsy for rashes and tumours?
Rashes - assist diagnosis
Tumours - assist diagnosis, remove cancer, cosmetics
What are the features of dermatofibroma?
Firm, increased pigment around rim
How does melanocytic naevi present?
Macule with a regular border, acquired during childhood/adolescence, depigmentation over years
What is the appearance of a basal cell papilloma?
Stuck on, cookie like
What is the system for looking at a malignant melanoma?
A - asymmetry B - border C - colour D - diameter E - evolution
How would you describe the blisters in bullous pemphigoid?
Large and tense
What are the limitations of skin biopsy in regard to rashes?
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)
How can we treat a superficial basal cell carcinoma?
Photodynamic therapy
Topical chemotherapy
How might we treat pre-cancers?
Cryotherapy Solaraze (NSAID) 5-FU (fluorouracil) Photodynamic therapy Imiquimod Resurfacing
Why would a patient on steroids warrant special care for skin surgery?
Reduced wound healing
Immunosupression
Why might a smoker warrant special care for skin surgery?
Smoking is associated with poor wound healing and graft rejection
How do we treat malignant melanoma skin cancer?
Surgery
Radiotherapy
Chemotherapy often useless
Which nerve supplies the muscles of mastication?
Trigeminal
Which nerve supplies the muscles of facial expression?
Facial
Which nerve may be damaged in an (angle of) mandible fracture?
Mandibular branch of the trigeminal
Which nerve may be damaged in a zygoma fracture?
Maxillary branch of trigeminal (transmitted through the inferior optic foramen)
Name three muscles of facial expression
Frontalis, orbicularis oculi, orbicularis oris
Name the methods of local anaesthesia
Topical
Local
Nerve block
Field block
Name a local anaesthetic
Lignocaine
Why is adrenaline useful in a local anaesthetic?
Reduces bleeding and prolongs affect of anaesthetic
When should adrenaline be avoided in local anaesthetic?
End arteries (nasal cartilage, fingers, toes)
What are some complications of skin biopsy?
Bleeding Wound dehiscence Nerve damage Loss of function Infection Scarring
When is electrosurgery used?
Haemostasis
Minor skin lesions (e.g tags)
When is a snip excision used?
Bulbous lesions which can be easily cut at the base
When is curettage used?
When the aim is for a minimally invasive procedure
When is shave excision used?
Small lesions that can be easily cut off
What are the positives of using a punch biopsy?
Quick, clean wound
What are the negatives of using a punch biopsy?
Round wounds do not heal well
Sample may be too small
Depth is hard to judge
What is the typical method of removal used in small skin lesions?
Elliptical excision
What types of surgery may be needed in larger lesions?
Grafts, flaps
