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Syllabus for Basic Dermatology Procedures May 27, 2006 ...

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  • 1. Syllabus for Basic Dermatology Procedures May 27, 2006 Introduction and Overview Biopsies- Scissors, Shave, Punch and Excision How to choose the correct biopsy for the lesion How to perform each of the biopsies 1. General Considerations for all biopsies a. Biopsy selectionbased upon anatomical site and lesion to be biopsied b. Informed consent c. Anesthetizing the area d. Biopsy mechanics ( scissor, shave, punch or excision) e. Tissue handling and preservation f. Hemostasis g. Closure (secondary or primary) h. Aftercare i. Potential complications j. Tracking and follow up of biopsy 2. Choosing the correct biopsy technique A. Type of lesion 1. Papule Scissor-epidermal lesion Shave-epidermal and some dermal involvement 2. Ulcerated or indurated lesion Punch- include edge of lesion 3. Pigmented macule Punch- total or partial if larger Excision 4. Rash Punch 5. Blister Punch- include edge of normal skin 3. Patient and Site Preparation for Biopsy A Patient Consent B.Mark area with surgical marker C. Photograph to include landmarks if possible D. Cleanse Area 1. Antibacterial Soap 2. Alcohol 3.Hibiclens 4.Povoiodine
  • 2. D. Anesthetize Area 1.1% or 2% Lidocaine A. with Epi- advantages b. Plain Lido-when and where c. Allergy considerations 2. Superfical or deep infiltration a. LesionType b. Infiltration technique for less pain 1. SLOW 2. Small needle- 30 gauge 3. Pinch 4. Snip or Scissor Biopsy A. Tools needed 1. Tissue scissors 2. Toothed forceps B. Technique 1. Hold tension on lesion and snip at base C. Hemostasis 1. Aluminum Chloride 2. Monsel’s Solution-may tattoo D .Secondary Healing E. Aftercare 5. Shave Biopsy A. Tools Needed 1. Deramablade of single #5 razor blade 2. Scalpel with #15 blade B. Anesthesia 1. Wheal C. Technique 1. Stretch skin taut 2. Shave horizontal 3. Use short “sawing movements D. Place Sample in bottle
  • 3. E. Hemostasis 1. Aluminum Chloride-make sure it is dry 2. May need heat cautery- coumadin, ASA F. Heal by secondary intent G. Aftercare-Ointment and Band Aid 6. Punch Biopsy A. Tools needed 1. Punch-What type and Size 2. Forceps 3. Tissue scissors 4. Needle Driver 5. Suture-What type and size B. Anesthesia 1. Deep and slow C. Technique 1. Stretch skin perpendicular to tension lines 2. Twist punch between index finger and thumb 3. Apply gentle pressure 4. Hold sample with forceps and snip base with scissors 5. May need hemostasis 6. Place sutures- D. Heal by primary intention- sutured 1. Interrupted skin sutures E. Aftercare 1. Ointment and band aid 2. Suture removal- when 7. Excision Biopsy A. Tools needed 1. Scalpel- #15 blade 2. Forceps-toothed 3. Scissor- tissues and suture 4. Needle Driver- Size based upon suture size 5. Cautery- heat or electrical B. Technique 1. Draw ellipse- orientation, angles and margins 2. Incise ellipse 3. Remove tissue with scalpel or scissor-use forceps for traction 4. Place specimen in bottle 5. Cauterize underlying vessels
  • 4. 6. Undermine a. What is undermining b. Why undermine? c. What do you use to undermine? d. Why not undermine? C. Primaryor Sutured Closure 1. Skin Suture a. Suture type 1. Location 2. Skin thickness and wound tension b. Suture Technique 1. Interrupted Stitch 2. Rule of halves 2. Dog Ears a. Definition B.Technique to remove dog ears D. Aftercare 1. Bandage-pressure 2. Wound Care 3. Suture Removal 8. Complications of any biopsy A. Bleeding B.Dehisence C. Scarring D. Infection 1. Is there a need for prophylactic antibiotics? E. Contact derm-ointment, band-aid F. Definitive therapy 9. Cryosurgery overview A. Lesions that can be treated with cryosurgery 1. Verruca, actinic keratoses, seborrheic keratoses, skin tags B. Lesions that should not be treated with cryosurgery 1. Nevi, melanoma C.Cryosurgery technique 1. Applicator method 2. Cryospray method 3. Freeze thaw cycle
  • 5. Location Deep Skin Face/Ear 5-0 absorbable (Vicryl) 5-0 Prolene or Nylon Extremities 3-0 or 4-0 absorbable (Vicyl ) 3-0 or 4-0 Prolene or Nylon Back 3-0 absorbable (Vicryl) 3-0 Prolene or Nylon Abdomen 3-0 or 4-0 absorbable (Vicryl) 3-0 or 4-0 Prolene or Nylon Scalp 2-0 or 3-0 Vicryl or no deep sutures 2-0 or 3-0 Prolene or Nylon Axilla 5-0 Vicryl 4-0 or 5-0 Silk Lips/Mucosa 5-0 absorbable 5-0 Silk or fast absorbing suture Low tension areas Absorbable Fast absorbing of appropriate size may be substituted

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