Tumour Surgery Flashcards
How are biopsies of skin rashes helpful?
They assist in diagnosis
How are biopsies of skin tumours helpful?
Assist in diagnosis, remove malignancy, remove unwanted skin growth
What are some features of dermatofibromas?
Firm to touch, often increased pigment around rim
What are some features of common melanocytic naevi?
Acquired during childhood and early adulthood, gradually lose pigment over years, usually regular (but not always)
Why might biopsies of rashes not always give a diagnosis?
Different skin conditions may have same histology (e.g different types of eczema), one cause of a skin condition can have several histology patterns (e.g drug eruptions)
What are some skin diseases due to adverse reactions to amoxicillin?
Morbiliform (measles-like) eruption, urticaria, angioedema, fixed drug eruption, generalised pustulosis
What must be obtained before a biopsy of a skin tumour can be taken?
Clinical diagnosis
What are some treatment options for skin tumours?
5-flurouracil, chemo/radiotherapy, cryotherapy, photodynamic therapy, surgery, imiquimod, solaraze
What are some treatments of non-melanoma skin cancers?
Surgery, 5% imiquimod cream
What are some treatments of common precancers?
Cryotherapy, solaraze, 5-FU, PDT, imiquimod, resurfacing
What are some aspects that should be taken into account during pre-operative planning?
Nature of procedure, medical and drug histories, bleeding disorder, allergies, pace maker, heart defects, epilepsy, diabetes
What are the treatments for melanoma skin cancers?
Initially surgery, may need further surgery, radiotherapy or chemotherapy
What are some important anatomical sites for skin surgery?
Tiger country (areas of concern due to superficial structures), eyelids, hairline, vermillion, scalp, skin tensions lines
What are the five layers of the scalp, from most to least superficial?
Skin, connective tissue, aponeurosis, loose connective tissue, pericranium
What does the trigeminal nerve supply (CN V)?
Sensory nerve supply to face, motor supply to muscles of mastication
What are the different divisions of the trigeminal nerve?
CN V1 = Ophthalmic division
CN V2 = Maxillary division
CN V3 = Mandibular division
How do you test the sensory component of the trigeminal nerve?
Ask patient to close eyes, gently brush skin in each dermatome with a fine tip of cotton wool, ask patient to tell you when they feel their skin being touched, compare the 2 sides
How do you test CN V2 function?
Ask patient to close eyes, gently brush over maxilla with a fine tip of cotton wool, ask patient to tell you when they feel their skin being touched, compare the 2 sides
How do you test the function of CN V3?
Ask the patient to close eyes, gently brush over the chin with a fine tip of cotton wool, ask patient to tell you when they feel their skin being touched, compare the 2 sides
What does the facial nerve (CN VII) supply?
Motor supply to muscles of facial expression, sense of taste
How do you test the function of the motor aspect of CN VII?
Ask patient to frown, close eyes tightly and smile
What are the methods of local anaesthesia?
Topical, local infiltration, nerve block, field block
What are some features of lignocaine (lidocaine)?
Amide type, excretion reduced in liver/renal/cardiac failure, young and elderly, max safe dose is 50ml of lignocaine with adrenaline, used for local anaesthesia
What are some features of adrenaline?
1:80000 to 1:200000, prolongs anaesthesia and reduces bleeding, avoid in patients with cardiac diseases or on psychotropic drugs, and in fingers and toes, used for local anaesthetic
What are some ways to reduce pain during local anaesthetic?
Relax patient, massage skin, topical local, slow injection, fine needle, subcutaneous injection, warm local, follicle opening, omit adrenaline, nerve blocks, neutralise acidity
What are some complications that can arise from a skin biopsy?
Bleeding, wound dehiscence, infection, scarring, loss of function, motor/sensory nerve damage
What are some basic skin surgery methods?
Electrosurgery (used for haemostasis and for treating minor skin lesions e.g skin tags), snip excision, curettage, shave excision, punch biopsy, elliptical excision (standard method for most small skin lesions)
What are some more specialised forms of skin surgery?
Laser, photodynamic therapy, dermabrasion, plastic surgery, Mohs microscopic surgery
How is a snip excision performed?
Grasp lesion with skin hook, cut across base of lesion
What are some features of curettage and cautery?
Minimally invasive procedure, pathology specimen doesn’t accurately record the margins of the tumour
What are the benefits and negatives of a punch biopsy?
Quick and produces good wound edges; Difficult to judge depth, round holes don’t always heal well, pathology sample may be too small
How is an elliptical excision performed?
Scalpel blade cuts at 90 degrees to skin surface giving wound vertical edges, when sides of ellipse are cut the base should then be cut through using scissors and pulling ellipse gently with skin hooks
