Skin Exam & Dermatology Procedures Flashcards Preview

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Flashcards in Skin Exam & Dermatology Procedures Deck (38)
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1

Goals of a Skin Exam

Determine general skin color & number of nevi
Screen for melanoma

2

ABC's of Screening for Melanoma

A: asymmetry
B: border irregularities
C: color variation
D: diameter
E: enlargement & evolution

3

Indications to Perform a Biopsy

All suspected neoplasms
All bullous disorders
Clarify a diagnosis when a limited number of entities are under consideration

4

Things to Known Before a Biopsy

Ask about allergies/reactions to topical antibiotics, local anesthetics, & tape
Know if a bleeding disorder, on aspirin or on warfarin

5

Biopsy Danger Zones

Areas overlying highly vascular structures
Areas associated with exit points of superficial nerves

6

Site Selection for Inflammatory Lesions

Biopsy those with characteristic inflammatory changes first

7

Site Selection for Blistering disease

Biopsy only newest vesicles or blisters
Remove vesicle intact with adjacent normal skin

8

Site Selection for Nonbullous Lesions

Maximal lesions skin & minimal normal skin
1-4 mm excise completely
Larger lesions: bx the edge, thickest portion or area that is most abnormal color

9

Site Selection for Bullae

Edge including small part of blister with adjacent intact skin

10

Considerations of Biopsies

Leave scars
Avoid cosmetic areas & areas with poor healing
Cosmetic areas: refer to derm or plastic surgeon

11

Anesthetic Used for Dermatology Procedures

Lidocaine 1%
Lidacaine 1% with epinephrine
Lidocaine 2.5% + Prilocaine 2.5%

12

Lidocaine 1%

Procedures including fingers, toes, nose, penis, or ear
May need to increase the pH

13

Lidocaine 1% with Epinephrine

NOT for procedures of the fingers, toes, nose, penis, or earlobes; or patients on non-selective beta blockers

14

Advantages of Epinephrine

Less bleeding
Prolongs anesthetic action
Allows larger volumes of anesthetic to be used safely

15

Local Anesthesia

Watch total dose administered
Insert needle through area just anesthetized
Lightly test skin or wound margins for adequate anesthesia

16

Field Block

For heavily contaminated wounds or when anesthetizing for I&D of a skin abscess
In a diamond formation

17

Langer's Lines

Pull wounds open in the direction of skin tension lines
Parallel the direction of the collagen n the dermis

18

Shave Biopsy

Small, depressed scar

19

Lesions Suitable for Shave Biopsies

Elevated & confined to the epidermis
Seborrheic or actinic keratoses
Skin tags
Small superficial lesions

20

Punch Biopsies

Special tool in different sizes
Inject anesthetic
Stabilize skin with the thumb & forefinger

21

Excisional Biopsy

Draw ellipse around lesion
Length 3x the width
Grab edge of area to be excised; dissect biopsy tissue
Undermine edges of the wound

22

Closing an Excisional Biopsy

Interrupted non absorbable sutures
Needle points defined: cutting, tapered, blunt

23

Needles FS

For skin
Thick skin

24

Needles CE

Cutting needles
Thick skin

25

Needles P

Plastic
Cosmetic

26

Needles PS

Plastic skin
Cosmetic closures

27

Suturing Elliptical Excisions

"Rule of halves"

28

Wound Care

Dressed with thin film of antibiotic ointment
Adhesive bandage
Shower after 24 hours
No baths or hot tubs until sutures out

29

Days for Suture Removal of Face, Back & Legs, Remainder of Body

Face: 3-5 days
Back & Legs: 10-14 days
Remainder of Body: 7-10 days

30

Post-op Complications

Bleeding
Infection
Allergic reactions to tape