Soft Tissue Disease (Deluke)

Question 1

What is the goal of the incisional biopsy and excisional biopsy?

Answer 1

Either get the entire lesion (excisional) or take a representative sample of the lesion (incisional)

Question 2

The following factors dictate what type of biopsy:

1. Lesion suspected to be malignant
2. Not clear whether lesion is inflammatory or neoplastic
3. Not clear whether a large mucosal lesion is hyperkeratosis or dysplasia
4. Lesion would require extensive surgery or is in a hazardous location

Answer 2

Incisional biopsy

Question 3

What is a biopsy that takes out the whole thing?

Answer 3

Excisional biopsy

Question 4

What is a biopsy that takes just a sample or portion?

Answer 4

Incisional

Question 5

How deep should an incisional biopsy extend?

Answer 5

Deep enough to include the actual lesion (e.g. at least to the basal cell layer)

Question 6

If the lesion is not homogenous, what biopsy should be done?

Answer 6

Incisional biopsy more than one area

Question 7

What are 2 things you should never biopsy?

Answer 7

1. Pigmented lesion

2. Vascular lesion

Question 8

What biopsy method is indicated for a small lesion not suspected to be malignant?

Answer 8

Excisional

Question 9

What is the most preferred biopsy (i.e. do this biopsy method whenever possible)?

Answer 9

Excisional

Question 10

What should be included in the local anesthetic and why when biopsying?

Answer 10

Epinephrine for hemostasis

Question 11

Should injection of local be done directly into the lesion to be biopsied?

Answer 11

No

Question 12

How should the biopsy specimen be handled?

Answer 12

Do not crush it

Question 13

What should you always do with a biopsy specimen?

Answer 13

Send for histologic diagnosis

Question 14

Why is it important to properly design an incision?

Answer 14

To avoid cutting out the lesion and leave a space that when closed creates an anatomical dead space that can get infected

Question 15

Which biopsy type is used for the following indications:

1. Diagnosis of cystic lesion
2. Diagnosis of suspected vascular lesion
3. Lesions that are not readily accessible for any of the other types of biopsy (e.g. salivary tumor)

Answer 15

Fine needle aspiration biopsy

Question 16

What is a biopsy where only surface cells are captured / biopsy is limited to only superficial cells?

Answer 16

Exfoliative cytology

Question 17

What is a biopsy that gives a transepithelial tissue sample, can even get down to the basal layer, but does not involve a scalpel?

Answer 17

Brush biopsy

Question 18

What is indicated for any ulcer that has been present for more than 2 weeks and has not healed?

Answer 18

Biopsy

Question 19

What is indicated if the diagnosis returned from a brush biopsy differs from your clinical impression?

Answer 19

Repeat the biopsy

Question 20

What are 4 things to consider int he treatment of benign tumors?

Answer 20

1. Character of the lesion
2. Anatomy
3. Preservation of function
4. Esthetics

Question 21

What are 4 descriptors of a lesion’s character?

Answer 21

1. Sessile (base is the widest part of the lesion)
2. Pedunculated (base is narrower than the widest part of the lesion)
3. Submucosal
4. Infiltrating

Question 22

What design would be used to remove a sessile or pedunculated lesion?

Answer 22

Elliptical

Question 23

What are 4 blood vessels to avoid in the mouth when designing biopsy?

Answer 23

1. Palatal
2. Incisive
3. Mental
4. Lingual

Question 24

What are 2 sensory nerves to avoid intramurally when doing biopsy?

Answer 24

1. Mental

2. Lingual

Question 25

What is a motor nerve to avoid when doing intramural biopsy?

Answer 25

Marginal mandibular

Question 26

What are 2 ducts to avoid when doing intramural biopsy?

Answer 26

1. Parotid

2. Submandibular

Question 27

Correct incisions are always in what relation to major anatomical structures?

Answer 27

Always parallel to major anatomical structures

Question 28

What are 3 areas of concern with respect to function when planning biopsy?

Answer 28

1. Commissures of the lips
2. Tongue
3. Soft palate

Question 29

When palpating a submucosal lesion, what should first be determined?

Answer 29

Is it fixed or is it mobile?

Question 30

If a submucosal lesion is fixed / immovable on palpation, what is indicated?

Answer 30

Infiltrating lesion requiring deeper biopsy

Question 31

What is the biopsy shape, the wound margin management, and closure type for a sessile and pedunculated lesion?

Answer 31

1. Elliptical modified wedge excision
2. Undermine wound margins
3. Primary closure

Question 32

What is the lesion biopsy design and closure for a submucosal (fixed / immobile) lesion?

Answer 32

1. Include overlying mucosa when excising lesion
2. Include a 0.5cm margin of normal tissue
3. Achieve proper hemostasis
4. Close in layers

Question 33

What is the advantage of using CO2 laser for biopsies?

Answer 33

Seals vessels and small nerve ending reducing post op pain and eliminating need for sutures

Question 34

What is the preferred biopsy method when feasible?

Answer 34

Excisional

Question 35

What biopsy is preferred for suspected malignant lesion?

Answer 35

Incisional

Question 36

What should you always use to confirm your clinical diagnosis of a lesion?

Answer 36

Histologic exam

Question 37

All biopsy patients require what?

Answer 37

Adequate follow-up

Question 38

What is the biopsy patient that should be followed-up diligently?

Answer 38

Those with dysplastic mucosal lesions