Tumour Surgery

Question 1

How are biopsies of skin rashes helpful?

Answer 1

They assist in diagnosis

Question 2

How are biopsies of skin tumours helpful?

Answer 2

Assist in diagnosis, remove malignancy, remove unwanted skin growth

Question 3

What are some features of dermatofibromas?

Answer 3

Firm to touch, often increased pigment around rim

Question 4

What are some features of common melanocytic naevi?

Answer 4

Acquired during childhood and early adulthood, gradually lose pigment over years, usually regular (but not always)

Question 5

Why might biopsies of rashes not always give a diagnosis?

Answer 5

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)

Question 6

What are some skin diseases due to adverse reactions to amoxicillin?

Answer 6

Morbiliform (measles-like) eruption, urticaria, angioedema, fixed drug eruption, generalised pustulosis

Question 7

What must be obtained before a biopsy of a skin tumour can be taken?

Answer 7

Clinical diagnosis

Question 8

What are some treatment options for skin tumours?

Answer 8

5-flurouracil, chemo/radiotherapy, cryotherapy, photodynamic therapy, surgery, imiquimod, solaraze

Question 9

What are some treatments of non-melanoma skin cancers?

Answer 9

Surgery, 5% imiquimod cream

Question 10

What are some treatments of common precancers?

Answer 10

Cryotherapy, solaraze, 5-FU, PDT, imiquimod, resurfacing

Question 11

What are some aspects that should be taken into account during pre-operative planning?

Answer 11

Nature of procedure, medical and drug histories, bleeding disorder, allergies, pace maker, heart defects, epilepsy, diabetes

Question 12

What are the treatments for melanoma skin cancers?

Answer 12

Initially surgery, may need further surgery, radiotherapy or chemotherapy

Question 13

What are some important anatomical sites for skin surgery?

Answer 13

Tiger country (areas of concern due to superficial structures), eyelids, hairline, vermillion, scalp, skin tensions lines

Question 14

What are the five layers of the scalp, from most to least superficial?

Answer 14

Skin, connective tissue, aponeurosis, loose connective tissue, pericranium

Question 15

What does the trigeminal nerve supply (CN V)?

Answer 15

Sensory nerve supply to face, motor supply to muscles of mastication

Question 16

What are the different divisions of the trigeminal nerve?

Answer 16

CN V1 = Ophthalmic division
CN V2 = Maxillary division
CN V3 = Mandibular division

Question 17

How do you test the sensory component of the trigeminal nerve?

Answer 17

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

Question 18

How do you test CN V2 function?

Answer 18

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

Question 19

How do you test the function of CN V3?

Answer 19

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

Question 20

What does the facial nerve (CN VII) supply?

Answer 20

Motor supply to muscles of facial expression, sense of taste

Question 21

How do you test the function of the motor aspect of CN VII?

Answer 21

Ask patient to frown, close eyes tightly and smile

Question 22

What are the methods of local anaesthesia?

Answer 22

Topical, local infiltration, nerve block, field block

Question 23

What are some features of lignocaine (lidocaine)?

Answer 23

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

Question 24

What are some features of adrenaline?

Answer 24

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

Question 25

What are some ways to reduce pain during local anaesthetic?

Answer 25

Relax patient, massage skin, topical local, slow injection, fine needle, subcutaneous injection, warm local, follicle opening, omit adrenaline, nerve blocks, neutralise acidity

Question 26

What are some complications that can arise from a skin biopsy?

Answer 26

Bleeding, wound dehiscence, infection, scarring, loss of function, motor/sensory nerve damage

Question 27

What are some basic skin surgery methods?

Answer 27

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)

Question 28

What are some more specialised forms of skin surgery?

Answer 28

Laser, photodynamic therapy, dermabrasion, plastic surgery, Mohs microscopic surgery

Question 29

How is a snip excision performed?

Answer 29

Grasp lesion with skin hook, cut across base of lesion

Question 30

What are some features of curettage and cautery?

Answer 30

Minimally invasive procedure, pathology specimen doesn’t accurately record the margins of the tumour

Question 31

What are the benefits and negatives of a punch biopsy?

Answer 31

Quick and produces good wound edges; Difficult to judge depth, round holes don’t always heal well, pathology sample may be too small

Question 32

How is an elliptical excision performed?

Answer 32

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