Benign vs. Cancer. Oculofacial Biopsy. Evolution of skin cancer. Richard E. Castillo, OD, DO

Size: px
Start display at page:

Download "Benign vs. Cancer. Oculofacial Biopsy. Evolution of skin cancer. Richard E. Castillo, OD, DO"

Transcription

1 Oculofacial Biopsy Richard E. Castillo, OD, DO Benign vs. Cancer Evolution of skin cancer Metaplasia Dysplasia Carcinoma-in-situ Invasive carcinoma Intravasation

2 Overview Preoperative Planning Choosing the appropriate biopsy technique based on tentative diagnosis Incisional vs excision biopsy Shave biopsy technique(s) Punch biopsy technique Full thickness/elliptical biopsy technique Submit specimen to lab Obtain and act on result Notify patient of most common adverse outcomes: Bleeding Infection Scaring Discuss the possibility of the need for additional procedures or therapy based on biopsy results

3 Be aware of underlying medical conditions and adjust procedure accordingly Underlying medical conditions: Atrial fibrillation Pacemaker Prosthetic heart valve or joint Hypertension Pregnancy Prior vasovagal response Hepatitis HIV MRSA COPD/O2 Be aware of underlying medical conditions and adjust procedure accordingly Take photographs - ALWAYS Be aware of underlying medical conditions and adjust procedure accordingly Take photographs - ALWAYS Consider biopsy location for healing characteristics Eyelid is VERY THIN SKIN! Biopsy may be accomplished with: Westcott Scissors Iris Scissors Gradle Scissors Scalpel (#15, 15c) RFS electrode* DermaBlade/razor blade Curette Know the differences in technique between the upper & lower eyelids, canthi, and periorbital skin *RFS: requires appropriate power, waveform and technique so that tissue sample is not damaged.

4 Be aware of underlying medical conditions and adjust procedure accordingly Take photographs - ALWAYS Consider biopsy location for healing characteristics AAA (Antibiotics, Antisepsis, Anesthesia) Antibiotics: Preoperative antibiotics are generally not necessary for clean surgical procedures such as skin biopsy when the biopsy is performed through clinically uninfected skin (American Heart Association) Antisepsis: Generally an alcohol wipe for 10 seconds is adequate for small biopsies. Other surgical scrubs may also be used for larger procedures or for patients at higher risk of infection. Anesthesia: Generally lidocaine 0.5% or 1% w/ or w/o epinephrine 1:100,000 or 1:200,000. Be aware of underlying medical conditions and adjust procedure accordingly Take photographs - ALWAYS Consider biopsy location for healing characteristics AAA (Antibiotics, Antisepsis, Anesthesia) Biopsy specimen handling Understand the medico-legal chain of custody Specimen transport fixative Formalin Saline Specific culture media Beware of tissue mishandling Pinch Twist Stretch Crush Burn Freeze Desiccate Follow through on path report Choosing the appropriate biopsy technique Will vary with type of lesion, depth, and location Suspected Melanoma always requires full-thickness biopsy with control of margins Superficial Spreading melanoma Nodular melanoma Acral lentiginous melanoma Broad, thin lamellar dissection or multiple smaller biopsies may show lentigo maligna melanoma best. Lentigo maligna melanoma is the most common subtype in eyelid skin Most common in lower eyelid Usually observed in year olds Suspected melanomas should be referred to experienced practitioners Lentigo maligna melanoma of the lower lid

5 Distribution of Eyelid Tumors Anatomic Site % Total Lower Eyelid 44 Medial Canthus 19 Eyebrow 17 Upper Eyelid 16 Lateral Canthus 4 TOTAL 100 MAJOR OCULOFACIAL BIOPSY TECHNIQUES Incisional Biopsy Excisional Biopsy Goal To remove a part of the lesion for diagnosis To remove entire lesion to subcutaneous plane Considerations Method Too large for excisional biopsy Cosmesis of complete removal not acceptable if benign process Diffuse inflammatory Shave process not Punch Ellipse Cosmesis improved if removed completely Malignant process suspected Deep scoop Shave Punch Ellipse Shave techniques Become comfortable with several biopsy instruments and techniques Scalpel Razor Dermal curette Scissors Practice with a skin substitute Tomatoes Oranges

6 Shave techniques: scalpel Enter skin with curve of blade (#15 or #15c) while holding skin taught Use short sawing motion with blade parallel to skin surface Depth is controlled by downward pressure on the blade Exit the skin by decreasing downward pressure and angleing slightly upward, allowing blade to resurface smoothly to complete the biopsy A cup-shaped defect is produced in the skin Attend to hemostasis Shave techniques: Razor Curve the blade by applying inward pressure on the balde from both sides Stretch the skin taught for a superficial shave Enter the skin in the center of the curved blade Use a short sawing motion with the center of the blade Depth is controlled by the amount of curve on the blade (more curve, more depth) as well as downward pressure Exit the skin by decreasing downward pressure and angleing slightly upward, allowing the blade to resurface smoothly to complete the biopsy

7 Shave techniques: dermal curette The desired biopsy area must fit within the area of the curette Stretch skin to provide a firm surface Entry, central depth, and exit are controlled by downward pressure A single fluid motion is preferred, as a fragmented specimen can compromise dingosis and margin analysis Shave techniques: scissors Eyelid biopsy may be performed with Westcott, iris, or Gradle scissors Prep & anesthetize Lift lesion gently with toothed 0.12mm tissue forceps Snip at base with scissors, flush with surrounding skin Attend to hemostasis Pressure Electrocautery Radiofrequency coagulation

8 Shave techniques: pearls Techniques may be practiced on oranges or tomatoes to simulate required force and motions to achieve even, controlled biopsies of appropriate depth To avoid a cup-like defect and maintain an even skin surface following biopsy of a raised lesion, anesthetic should be placed in the deep dermis, and allowed to diffuse for minutes. The skin should be stretched taught during the shave Punch technique Appropriately sized punch should be placed perpendicular to skin surface Stretch the surface of the skin to provide a firm surface (increase sectility of the tissue) Apply even downward pressure while rotating the punch until desired thickness is achieved Withdraw punch Grasp specimen gently with toothed (0.12 mm) forceps or lift with tip of needle. Do not crush! Use tissue scissors to free the base Hemostasis may be achieved with pressure, suture, or gel foam. Apply pressure dressing Punch techniques: pearls To avoid inadvertent crushing with forceps, a 27-gauge or 30-gauge needle may be used to elevate the specimen out of the skin To make an elliptical defect with a circular punch, apply lateral stretch on the skin in the direction in which the short axis of the ellipse is desired (perpendicular to the relaxed lines of skin tension)

9 Elliptical incisional/excisional technique Place scalpel or RF electrode straight wire perpendicular to skin surface and incise to desired depth along predetermined outline Outline should be elliptical to allow for linear closere or circular to allow for healing by secondary intention Once outline is incised, use tissue forceps or needle to lift tissue to reveal its base Use scalpel, scissors, of RFS electrode wire to free the base of the specimen parallel to the surface Undermine edges for linear closure Achieve hemostats Attend to wound closure with buried absorbable sutures to relieve tensions and superficial sutures to align skin edges Biopsy specimen Each lab has their own specific handling instructions for biopsy At a minimum specimens are labeled with patients name, specimen location, and if multiple specimens submitted, each numbered or lettered for individual identification. Formalin is the transport medium for routine light microscopy Specimens sent for direct immunofluorescence are placed in Michael s solution or taken directly to the lab in saline Suspected sebaceous cell carcinoma is submitted fresh, wrapped in a saline-soaked gauze Clinical history and lesion description must be included so that proper clfinicopathologic correlation can be made

10 Thank you!

Office-Based Surgery! for the Optometric Physician! ADVANCED PRACTICE OPTOMETRY! DISCLOSURE

Office-Based Surgery! for the Optometric Physician! ADVANCED PRACTICE OPTOMETRY! DISCLOSURE Office-Based Surgery! for the Optometric Physician! ADVANCED PRACTICE OPTOMETRY! Richard E. Castillo, OD, DO! Medical & Surgical Ophthalmology! Tahlequah, OK! DISCLOSURE I have no financial interest in

More information

Basics of Skin Biopsy Techniques

Basics of Skin Biopsy Techniques Basics of Skin Biopsy Techniques Kelly Quinn, D.O. Lehigh Valley Health Network/PCOM Department of Dermatology Osteopathic Medical Conference and Exposition October 7, 2017 None to disclose Conflicts of

More information

Skin Biopsy and Basic Dermatological Procedures

Skin Biopsy and Basic Dermatological Procedures Skin Biopsy and Basic Dermatological Procedures 1 LOU MANCANO MD READING HEALTH SYSTEM - READING, PA DEPT. OF FAMILY AND COMMUNITY MEDICINE PA. ACADEMY OF FAMILY PHYSICIANS JULY 28, 2015 Disclosure Dr.

More information

University of Utah. Cutaneous Nerve Evaluation. Please read through all information BEFORE scheduling patient s biopsy

University of Utah. Cutaneous Nerve Evaluation. Please read through all information BEFORE scheduling patient s biopsy University of Utah Cutaneous Nerve Evaluation Please read through all information BEFORE scheduling patient s biopsy Now 1) Open the enclosed kit and FREEZE the cold pack for return shipment 2) Keep everything

More information

M A H O M E W O R K # 2 P a g e Outpatient surgery is generally limited to procedures requiring less than 60

M A H O M E W O R K # 2 P a g e Outpatient surgery is generally limited to procedures requiring less than 60 M A 2 0 5 H O M E W O R K # 2 P a g e 1 NAME: DATE: CHAPTER 42 Assisting with Minor Surgery True/False: 1. Outpatient surgery is generally limited to procedures requiring less than 60 minutes to perform.

More information

Implanting an Adult Rat with the Single-Channel Epoch Transmitter for Recording Electrocardiogram in the Type II electrode configuration.

Implanting an Adult Rat with the Single-Channel Epoch Transmitter for Recording Electrocardiogram in the Type II electrode configuration. Implanting an Adult Rat with the Single-Channel Epoch Transmitter for Recording Electrocardiogram in the Type II electrode configuration. Recommended Surgical Tools A. Scalpel handle B. Scalpel blade (#15)

More information

Mc Gregor Flap for Lower Eyelid Defect

Mc Gregor Flap for Lower Eyelid Defect IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 16, Issue 4 Ver. V (April. 2017), PP 69-74 www.iosrjournals.org Mc Gregor Flap for Lower Eyelid Defect

More information

Surgery/Integumentary System ( )

Surgery/Integumentary System ( ) 10030 The provider inserts a catheter through the skin using imaging to view the fluid. He then drains the fluid from the soft tissue in cases such as abscess, hematoma, seroma, lymphocele, or cyst. Imaging

More information

Ophthalmology Wet Lab Notes - Kimberly Hsu, DVM, MSc, DACVO

Ophthalmology Wet Lab Notes - Kimberly Hsu, DVM, MSc, DACVO Ophthalmology Wet Lab Notes - Kimberly Hsu, DVM, MSc, DACVO If you have questions, please do not hesitate to call Dr. Hsu at Eye Care for Animals, St. Charles at 630-444-0393 or email at stcharlesinfo@eyecareforanimals.com

More information

How to Perform a Punch Biopsy of the Skin

How to Perform a Punch Biopsy of the Skin T h e n e w e ngl a nd j o u r na l o f m e dic i n e videos in clinical medicine summary points How to Perform a Punch Biopsy of the Skin Jacob Levitt, M.D., Sebastian Bernardo, M.D., and Talley Whang,

More information

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE

Surgical Care at the District Hospital. EMERGENCY & ESSENTIAL SURGICAL CARE Surgical Care at the District Hospital 1 5 Basic Surgical Procedures Key Points 2 5.1 Wound Management Many important procedures can be performed under local anesthesia and do not require a surgical specialist

More information

International Council of Ophthalmology s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR)

International Council of Ophthalmology s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) International Council of Ophthalmology s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) The International Council of Ophthalmology s Ophthalmology Surgical Competency Assessment Rubrics

More information

Coding Wars: The Coding and Documentation Weapons to Win the Battle

Coding Wars: The Coding and Documentation Weapons to Win the Battle Coding Wars: The Coding and Documentation Weapons to Win the Battle Howard W. Rogers M.D., Ph.D. Advanced Dermatology Norwich, CT rogershoward@sbcglobal.net Conflict of Interest Statement I have no relevant

More information

You Were Audited for What? Tales From the Trenches

You Were Audited for What? Tales From the Trenches You Were Audited for What? Tales From the Trenches Howard W. Rogers M.D., Ph.D. Advanced Dermatology Norwich, CT rogershoward@sbcglobal.net Conflict of Interest Statement I have no relevant financial conflicts

More information

Course # Lid Neoplasms and Procedures

Course # Lid Neoplasms and Procedures Course # 103 Lid Neoplasms and Procedures Entropion Lid Neoplasms and Procedures MICHELLE WELCH, O.D. CHOCTAW NATION HEALTH SERVICES AUTHORITY Inward turn of eyelid usually lower lid For mild entropion,

More information

In Office Optometric Lid Procedures

In Office Optometric Lid Procedures In Office Optometric Lid Procedures MICHELLE WELCH, O.D. CHOCTAW NATION HEALTH SERVICES AUTHORITY rmwelch@cnhsa.com 1 Entropion Inward turn of eyelid usually lower lid For mild entropion, repair by suture

More information

STANDARD OPERATING PROCEDURE #203 LARGE ANIMAL SURGERY

STANDARD OPERATING PROCEDURE #203 LARGE ANIMAL SURGERY STANDARD OPERATING PROCEDURE #203 LARGE ANIMAL SURGERY 1. PURPOSE This Standard Operating Procedure (SOP) describes procedures for general surgery of large animal species such as swine, dogs, rabbits,

More information

Surgical Approach and Occlusion of the Vasa

Surgical Approach and Occlusion of the Vasa From No-Scalpel Vasectomy: An Illustrated Guide for Surgeons, Third Edition 2003 EngenderHealth 5 Surgical Approach and Occlusion of the Vasa A lthough the no-scalpel technique is almost bloodless, an

More information

Principles of plastic and reconstructive surgery

Principles of plastic and reconstructive surgery Plastic surgery - in general Principles of plastic and reconstructive surgery Dr. T. Németh, DVM, Ph.D, Diplomate ECVS Assoc. Professor and Head Definition: Surgical correction of morphological and/or

More information

Surgical Skills Surgical Workshop GPCME South Meeting Dunedin August Kate Heer, Mathew Leaper Peter Chapman-Smith

Surgical Skills Surgical Workshop GPCME South Meeting Dunedin August Kate Heer, Mathew Leaper Peter Chapman-Smith Surgical Skills Surgical Workshop GPCME South Meeting Dunedin August 2014 Kate Heer, Mathew Leaper Peter Chapman-Smith Thanks to Zac Moaveni and Adam Bialostocki. Minor Plastic Surgical Procedures Minor

More information

EndoBlade Soft Tissue Release System

EndoBlade Soft Tissue Release System Surgical Technique Endoscopic Gastroc Recession Endoscopic Plantar Fascia Release EndoBlade Soft Tissue Release System Endoscopic Gastroc Recession Arthrex has developed a comprehensive, completely disposable

More information

6 main methods of biopsy. Introduction. Curettage Snip/Scissor Shave Punch Incisional Excisional in toto (also curative)

6 main methods of biopsy. Introduction. Curettage Snip/Scissor Shave Punch Incisional Excisional in toto (also curative) 6 main methods of biopsy Introduction Curettage Snip/Scissor Shave Punch Incisional Excisional in toto (also curative) Wrecked em Protect em Wear eye protection! Wear gloves! Use standard precautions!

More information

Victoria Lazareth, MA, MSN, NP-C, DCNP

Victoria Lazareth, MA, MSN, NP-C, DCNP Maui Derm for NP+PA Surgical Workshop Victoria Lazareth, MA, MSN, NP-C, DCNP Associate Professor UMass Graduate School of Nursing Associate Professor Simmons College Graduate School of Nursing Dermatology

More information

Melanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media

Melanoma and Dermoscopy. Disclosure Statement: ABCDE's of melanoma. Co-President, Usatine Media Melanoma and Dermoscopy Richard P. Usatine, MD, FAAFP Professor, Family and Community Medicine Professor, Dermatology and Cutaneous Surgery Medical Director, University Skin Clinic University of Texas

More information

Initial placement 24FR Pull PEG kit REORDER NO:

Initial placement 24FR Pull PEG kit REORDER NO: Initial placement 24FR Pull PEG kit REORDER NO: 00710805 INSTRUCTIONS FOR USE 1 of 5 These products have been manufactured not to include latex. Intended Use: The Initial placement 24FR Pull PEG kit is

More information

Primary Care Dermatology Coding. Webinar Subscription Access Expires December 31.

Primary Care Dermatology Coding. Webinar Subscription Access Expires December 31. Primary Care Dermatology Coding Questions Answers Webinar Subscription Access Expires December 31. How long can I access the on demand version? You will find that in the same instructions box you utilized

More information

BP and Heart Rate by Telemetry

BP and Heart Rate by Telemetry BP and Heart Rate by Telemetry Version: 1 Modified from: Butz et al. Physiol Genomics. 2001 Mar 8;5(2):89-97. Edited by: Dr. Lynette Bower, UC Davis Summary Reagents and Materials Protocol Reagent Preparation

More information

EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM

EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM EndoRelease ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM SURGICAL TECHNIQUE Up p e r Ex t r e m i t y So l u t i o n s ENDOSCOPIC CUBITAL TUNNEL RELEASE SYSTEM Description: The EndoRelease Endoscopic Cubital

More information

Special Techniques in the Diagnosis of Oral Cancer*

Special Techniques in the Diagnosis of Oral Cancer* Special Techniques in the Diagnosis of Oral Cancer* Biopsy: Definitive Diagnosis of Oral Cancer HarveyW. Baker, M.D. Oral Exfoliative Cytology: An Adjunct to Biopsy N. H. Rickles, D.D.S., M.S. Staining

More information

Placing PEG and Jejunostomy Tubes in Dogs and Cats

Placing PEG and Jejunostomy Tubes in Dogs and Cats Placing PEG and Jejunostomy Tubes in Dogs and Cats I. Gastrostomy tube A. Percutaneous Endoscopic Gastrostomy (PEG) tube placement Supplies for PEG tube placement: Supplies and equipment for general anesthesia

More information

STAB INCISION GLAUCOMA SURGERY (SIGS)

STAB INCISION GLAUCOMA SURGERY (SIGS) STAB INCISION GLAUCOMA SURGERY (SIGS) Dr. Soosan Jacob, MS, FRCS, DNB Senior Consultant Ophthalmologist, Dr. Agarwal's Eye Hospital, Chennai, India dr_soosanj@hotmail.com Videos available in Youtube channel:

More information

Minor Surgery. Using the Limbs & Things skin pads and jig. Skin Pad Jig Mk 3. Skin Pad Jig Strap. 44 Minor Surgery

Minor Surgery. Using the Limbs & Things skin pads and jig. Skin Pad Jig Mk 3. Skin Pad Jig Strap. 44 Minor Surgery Using the Limbs & Things skin pads and jig The Skin Pad Jig can be used initially on a work surface for ease of learning, and can then be attached to the body of a fellow trainee to practise these skills,

More information

Skin Cut Up D R R O K I A H A L I C O N S U L T A N T D E R M A T O P A T H O L O G I S T S T H

Skin Cut Up D R R O K I A H A L I C O N S U L T A N T D E R M A T O P A T H O L O G I S T S T H Skin Cut Up D R R O K I A H A L I C O N S U L T A N T D E R M A T O P A T H O L O G I S T S T H General Instructions 5.1.1 The type of biopsy is documented. 5.1.2 Orientated or not (suture indicating what

More information

17 Follicular Unit Extraction

17 Follicular Unit Extraction In: Haber RS, Stough DB, editors: Hair Transplantation, Chapter 17. Elsevier Saunders, 2006: 133-137. 2006, Elsevier Inc 17 Follicular Unit Extraction William R. Rassman, James A. Harris, Robert M. Bernstein

More information

Ophthalmologist Southern Eye Specialists Christchurch Eye Surgery Christchurch

Ophthalmologist Southern Eye Specialists Christchurch Eye Surgery Christchurch Dr Rebecca Stack Ophthalmologist Southern Eye Specialists Christchurch Eye Surgery Christchurch Mr Rob Weatherhead Ophthalmologist Southern Eye Specialists Christchurch Eye Surgery Christchurch Dr Peter

More information

What are melanocytes? Who is at risk of melanoma? Soalas Dermatolgoy & Laser Clinic. Page 1

What are melanocytes? Who is at risk of melanoma? Soalas Dermatolgoy & Laser Clinic. Page 1 Melanoma Malignant melanoma is a potentially serious type of skin cancer. It is due to uncontrolled growth of pigment cells, called melanocytes. New Clinical Guidelines on the Management of Melanoma in

More information

Using the Mohs Technique for Thin Melanomas

Using the Mohs Technique for Thin Melanomas Dermatology Associates Mohs Micrographic Surgery 2300 W Stone Drive Kingsport TN 37660 Telephone 423-246-4961 1-800-445-7274 (VA Toll Free) Fax 423-245-1200 Using the Mohs Technique for Thin Melanomas

More information

Endoscopy. Pulmonary Endoscopy

Endoscopy. Pulmonary Endoscopy Pulmonary 1 Direct visualization of TB tree Developed in 1890 s to remove foreign bodies - rigid metal tube Advances added light system, Sx Flexible fiberoptic scopes introduced in early 1960 s 2 Used

More information

Nodular Basal Cell Carcinoma PIGMENTED BASAL CELL. Squamous cell carcinoma

Nodular Basal Cell Carcinoma PIGMENTED BASAL CELL. Squamous cell carcinoma Malignant Tumors of the Eyelids Management of Eyelid Neoplasms Michelle Welch, O.D. NSU Oklahoma College of Optometry Pearls Most periocular tumors are derived from epidermis or adnexae Main goal rule

More information

TIMEDSURGERY DIRECT-MODE PROGRAMME DATA

TIMEDSURGERY DIRECT-MODE PROGRAMME DATA Bipolar coagulation Direct Coag 4 50 Bipolar forceps Monopolar 8-10 of vessels macroelectrodes Comment: Recommended for haemostasis in microsurgery Coagulation of Direct Coag 50 or 72 EM 15 + forceps Monopolar

More information

MOHS MICROGRAPHIC SURGERY: AN OVERVIEW

MOHS MICROGRAPHIC SURGERY: AN OVERVIEW MOHS MICROGRAPHIC SURGERY: AN OVERVIEW SKIN CANCER: Skin cancer is far and away the most common malignant tumor found in humans. The most frequent types of skin cancer are basal cell carcinoma, squamous

More information

Minor Surgical Procedures (Blades and Radio - Waves) Jason D. Duncan, OD, FAAO

Minor Surgical Procedures (Blades and Radio - Waves) Jason D. Duncan, OD, FAAO Minor Surgical Procedures (Blades and Radio - Waves) Jason D. Duncan, OD, FAAO jduncan@sco.edu I. Introduction and objectives II. Medico legal a. Standard of care b. State laws c. Informed consent i. Available

More information

Basic Laceration Repair

Basic Laceration Repair videos in clinical medicine Basic Laceration Repair Todd W. Thomsen, M.D., Derek A. Barclay, M.D., and Gary S. Setnik, M.D. From the Department of Emergency Medicine, Mount Auburn Hospital, Cambridge,

More information

General information about skin cancer

General information about skin cancer Skin Cancer General information about skin cancer Key points Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin. There are different types of cancer that start in

More information

Primary Cutaneous Melanoma Pathology Reporting Proforma DD MM YYYY. *Tumour site. *Specimen laterality. *Specimen type

Primary Cutaneous Melanoma Pathology Reporting Proforma DD MM YYYY. *Tumour site. *Specimen laterality. *Specimen type Primary Cutaneous Melanoma Pathology Reporting Proforma Includes the International Collaboration on Cancer reporting dataset denoted by * Family name Given name(s) Date of birth DD MM YYYY Sex Male Female

More information

Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman

Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman Breast conservation surgery and sentinal node biopsy: Dr R Botha Moderator: Dr E Osman Breast anatomy: Breast conserving surgery: The aim of wide local excision is to remove all invasive and in situ

More information

Peripheral Extracranial Neurostimulation for the treatment of Primary Headache and Migraine:

Peripheral Extracranial Neurostimulation for the treatment of Primary Headache and Migraine: Chapter 19 Peripheral Extracranial Neurostimulation for the treatment of Primary Headache and Migraine: Introduction 1) The occipital nerve is involved in pain syndromes originating from nerve trauma,

More information

How-To Booklet: Pediatric Spay-Neuter. Surgical Techniques Pictorial

How-To Booklet: Pediatric Spay-Neuter. Surgical Techniques Pictorial How-To Booklet: Pediatric Spay-Neuter Surgical Techniques Pictorial Brenda Griffin, DVM, MS, DACVIM 1. Approach to Scrotal Neuter for Puppies 2. Cord Tie 3. Figure 8 Knot 4. Ovarian Pedicle Tie 5. Modified

More information

Malignant tumors of melanocytes : Part 3. Deba P Sarma, MD., Omaha

Malignant tumors of melanocytes : Part 3. Deba P Sarma, MD., Omaha Malignant tumors of melanocytes : Part 3 Deba P Sarma, MD., Omaha Let s go over one case of melanoma using the following worksheet. Of the various essential information that needs to be included in the

More information

J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 39/ May 14, 2015 Page 6824

J of Evolution of Med and Dent Sci/ eissn , pissn / Vol. 4/ Issue 39/ May 14, 2015 Page 6824 SCAR EVALUATION IN PATIENTS UNDERGOING MELANOCYTIC NEVI EXCISION BY PUNCH EXCISION TECHNIQUE: A PILOT STUDY Kanathur Shilpa 1, Savitha Somaiah 2, H. V. Nataraja 3, D. V. Lakshmi 4, Gorur Divya 5 HOW TO

More information

1 BIOPSY AND CYTOLOGY

1 BIOPSY AND CYTOLOGY BIOPSY AND CYTOLOGY Biopsy Definition Biopsy is the removal of a sample of living tissue for laboratory examination. Rationale It is a dentist s obligation to make a diagnosis, or see that a diagnosis

More information

Initial placement 20FR Guidewire PEG kit REORDER NO:

Initial placement 20FR Guidewire PEG kit REORDER NO: Initial placement 20FR Guidewire PEG kit REORDER NO: 00710802 INSTRUCTIONS FOR USE 1 of 5 These products have been manufactured not to include latex. Intended Use: The Initial placement 20FR Guidewire

More information

Dynamics of FUE. Parsa Mohebi, MD, FISHRS I Encino, California, USA I Jeanette Straga, DO I Encino, California, USA

Dynamics of FUE. Parsa Mohebi, MD, FISHRS I Encino, California, USA I Jeanette Straga, DO I Encino, California, USA Dynamics of FUE Parsa Mohebi, MD, FISHRS I Encino, California, USA I info@parsamohebi.com; Jeanette Straga, DO I Encino, California, USA ABSTRACT There are a number of basic principles that every hair

More information

Property Latmedical, LLC.

Property Latmedical, LLC. Dr. Goed provides a complete and innovate product portfolio solution to the growing healthcare need within the field of non-invasive orthopedics, sports medicine, bandaging, wound care and compression

More information

Transfemoral Amputation

Transfemoral Amputation Transfemoral Amputation Pre-Op: 42 year old male who sustained severe injuries in a motorcycle accident. Note: he is a previous renal transplant recipient and is on immunosuppressive treatments. His injuries

More information

CAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE

CAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE CAREFULLY READ ALL INSTRUCTIONS PRIOR TO USE INDICATIONS FOR USE The LATERA Absorbable Nasal Implant is indicated for supporting upper and lower lateral nasal cartilage. CAUTION: Federal law restricts

More information

Surgery, integumentary system

Surgery, integumentary system Surgery, integumentary system 1. James suffered a severe crushing injury to his left upper leg. Two days after surgery, Dr. Barnes completed a dressing change under general anesthesia. How would you report

More information

DENTAL EXTRACTIONS MADE EASIER. Brook A. Niemiec, DVM

DENTAL EXTRACTIONS MADE EASIER. Brook A. Niemiec, DVM DENTAL EXTRACTIONS MADE EASIER Brook A. Niemiec, DVM Diplomate, American Veterinary Dental College Diplomate, European Veterinary Dental College Fellow, Academy of Veterinary Dentistry San Diego Vet Dental

More information

UWMC Roosevelt Clinic Rotation Goals 2011 Procedural Dermatology Fellowship Program 1

UWMC Roosevelt Clinic Rotation Goals 2011 Procedural Dermatology Fellowship Program 1 Procedural Dermatology Fellowship Objectives University of Washington Medical Center-Roosevelt Rotation The primary goal of the University of Washington rotation of the Procedural Dermatology fellowship

More information

Injection Techniques Principles and Practice. Introduction. Learning Objectives 5/18/2015. Richard E. Castillo, OD, DO

Injection Techniques Principles and Practice. Introduction. Learning Objectives 5/18/2015. Richard E. Castillo, OD, DO Injection Techniques Principles and Practice Richard E. Castillo, OD, DO Administering injections is considered a routine clinic activity Safety demands knowledge of: Anatomy & Physiology Pharmacology

More information

The Reverse Galeal Hinge Flap: Another Valuable Technique in the Repair of Scalp

The Reverse Galeal Hinge Flap: Another Valuable Technique in the Repair of Scalp TITLE PAGE TITLE: The Reverse Galeal Hinge Flap: Another Valuable Technique in the Repair of Scalp Defects Extending to the Calvarium AUTHORS: Lam, Thomas, BA; Indiana University School of Medicine Miletta,

More information

Colorectal procedure guide

Colorectal procedure guide Colorectal procedure guide Illustrations by Lisa Clark Biodesign ADVANCED TISSUE REPAIR cookmedical.com 2 INDEX Anal fistula repair Using the Biodesign plug with no button.... 4 Anal fistula repair Using

More information

Cervical Conization. 1

Cervical Conization.   1 Cervical Conization www.zohrehyousefi.com 1 Cone Biopsy is a surgical procedure with removal of a cone shaped portion of the cervix The extent of involvement of epithelium on the ectocervix has been clearly

More information

BICEPTOR Tenodesis System

BICEPTOR Tenodesis System BICEPTOR Tenodesis System Sub-Pectoral Biceps Tenodesis A Shoulder Series Technique Guide As described by: Nikhil N. Verma, MD As described by: Nikhil N. Verma, MD Midwest Orthopedics at Rush Chicago,

More information

ASEPT. Pleural Drainage System INSTRUCTIONS FOR USE. Rx only REF LOT. STERILE EO Sterilized using ethylene oxide

ASEPT. Pleural Drainage System INSTRUCTIONS FOR USE. Rx only REF LOT. STERILE EO Sterilized using ethylene oxide ASEPT Pleural Drainage System INSTRUCTIONS FOR USE L1171/D REV 2014-02 2 Do not reuse 2 STERILIZE Do not resterilize Store at room temperature STERILE EO Sterilized using ethylene oxide Rx only Do not

More information

Histopathology: skin pathology

Histopathology: skin pathology Histopathology: skin pathology These presentations are to help you identify, and to test yourself on identifying, basic histopathological features. They do not contain the additional factual information

More information

Dermatology Procedure Coding

Dermatology Procedure Coding Dermatology Procedure Coding Anatomy Two layers that make up human skin Epidermis most superficial layer Composed of four to five layers called stratum Anyone remember the mnemonic? Thickness varies based

More information

Malignant Melanoma Early Stage. A guide for patients

Malignant Melanoma Early Stage. A guide for patients This melanoma patient brochure is designed to help educate melanoma patients and their caregivers. It was developed under the guidance of Dr. Michael Smylie, Professor, Department of Oncology, University

More information

Surgical Procedure in Guided Tissue Regeneration with the. Inion GTR Biodegradable Membrane System

Surgical Procedure in Guided Tissue Regeneration with the. Inion GTR Biodegradable Membrane System Surgical Procedure in Guided Tissue Regeneration with the Inion GTR Biodegradable Membrane System 1 Introduction This presentation familiarizes you with the basic steps how to use the Inion GTR membrane

More information

Wound Repair. Epidemiology. History. Location of Injuries Face/Scalp Extremities. Legal Risk Missed FB and Fx Infection

Wound Repair. Epidemiology. History. Location of Injuries Face/Scalp Extremities. Legal Risk Missed FB and Fx Infection Wound Repair Edwin W. Schaefer, DNP, R.N. - FNP Emergency Nurse Practitioner Epidemiology Location of Injuries Face/Scalp Extremities Legal Risk Missed FB and Fx Infection History Mechanism of Injury Associated

More information

Dr. Brent Doolan, BSc MBBS MPH

Dr. Brent Doolan, BSc MBBS MPH Impact of partial biopsies on the need for complete excisional surgery in the management of cutaneous melanomas: A multi-centre review Dr. Brent Doolan, BSc MBBS MPH Peter MacCallum Cancer Centre, Melbourne

More information

Handbook of Dermatologic Surgery

Handbook of Dermatologic Surgery Handbook of Dermatologic Surgery Handbook of Dermatologic Surgery Elizabeth Hale, M.D. New York University of School of Medicine New York, NY, USA Julie Karen, M.D. New York University of School of Medicine

More information

STAB INCISION GLAUCOMA SURGERY (SIGS) AMAR AGARWAL

STAB INCISION GLAUCOMA SURGERY (SIGS) AMAR AGARWAL STAB INCISION GLAUCOMA SURGERY (SIGS) AMAR AGARWAL SIGS or Stab Incision Glaucoma Surgery is a guarded filtration procedure that was introduced by me and is slowly but surely becoming popular amongst many

More information

ASEPT Pleural Drainage System

ASEPT Pleural Drainage System ORDERING INFORMATION ASEPT Drainage PRODUCTS (Provided separately, see package label for contents) ASEPT Pleural Drainage System 622289 (1 each) (includes ASEPT Pleural drainage catheter and insertion

More information

Identifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018

Identifying Skin Cancer. Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 Identifying Skin Cancer Mary S. Stone MD Professor of Dermatology and Pathology University of Iowa Carver College of Medicine March, 2018 American Cancer Society web site Skin Cancer Melanoma Non-Melanoma

More information

Use of Histopathology and Microbiology in Veterinary Dermatology

Use of Histopathology and Microbiology in Veterinary Dermatology Use of Histopathology and Microbiology in Veterinary Dermatology Dr R D Last BVSc; M.Med.Vet (Pathology) Specialist Veterinary Pathologist Introduction The skin is the largest of the organ systems and

More information

,5 mm mm

,5 mm mm Mini luxators These mini luxators have an anatomically curved blade to adapt to the tooth root. Through a slight rotating movement the periodontal ligaments can be cut cleanly, at the same time dilating

More information

NIDCD NATIONAL TEMPORAL BONE, HEARING AND BALANCE PATHOLOGY RESOURCE REGISTRY

NIDCD NATIONAL TEMPORAL BONE, HEARING AND BALANCE PATHOLOGY RESOURCE REGISTRY NIDCD NATIONAL TEMPORAL BONE, HEARING AND BALANCE PATHOLOGY RESOURCE REGISTRY Guidelines for Removal of Temporal Bones for Pathological Study The temporal bones should be removed as soon as possible. If

More information

STAB INCISION GLAUCOMA SURGERY (SIGS)

STAB INCISION GLAUCOMA SURGERY (SIGS) STAB INCISION GLAUCOMA SURGERY (SIGS) DR. SOOSAN JACOB Dr. Agarwal's Eye Hospital, Chennai, India dr_soosanj@hotmail.com Youtube channel*: Dr. Soosan Jacob SIGS or Stab Incision Glaucoma Surgery is a guarded

More information

Protocol for Removal and Preservation of the Urinary Bladder

Protocol for Removal and Preservation of the Urinary Bladder Protocol for Removal and Preservation of the Urinary Bladder Version: 1 Replaced by version: N/A Edited by: Firuoz Danashgeri, MD Summary Reagents and Materials Protocol Reagent Preparation Kreb s Solution

More information

SURGICAL PROCEDURE DESCRIPTIONS

SURGICAL PROCEDURE DESCRIPTIONS SURGICAL PROCEDURE DESCRIPTIONS GONADECTOMY: CASTRATION USING SCROTAL METHOD 1. The animal is anesthetized and placed in dorsal recumbency with the tail toward the surgeon. 2. The abdominal and scrotal

More information

Ferromagnetic Dissection: A Comparison to Electrosurgery

Ferromagnetic Dissection: A Comparison to Electrosurgery Ferromagnetic Dissection: A Comparison to Electrosurgery Written by Kim Manwaring, M.D., Chief Medical Officer, Domain Surgical, Inc. Compared to electrosurgery, ferromagnetic dissection achieves superior

More information

Skin Cancer and Mohs Micrographic Surgery Patient Education

Skin Cancer and Mohs Micrographic Surgery Patient Education Patient Care Services 300 Pasteur Drive Stanford, CA 94305 Skin Cancer and Mohs Micrographic Surgery Patient Education Skin Cancer How Common is Skin Cancer? Skin cancer is the most common form of cancer

More information

PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique

PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique PediLoc 3.5mm and 4.5mm Contour Femur Plate Surgical Technique Surgical Technique Contour Femur Plate The technique description herein is made available to the healthcare professional to illustrate the

More information

SKIN SERVICES REVIEW Changes to Medicare Benefits Schedule for 1 November 2016

SKIN SERVICES REVIEW Changes to Medicare Benefits Schedule for 1 November 2016 Attachment A SKIN SERVICES REVIEW Changes to Medicare Benefits Schedule for 1 November 2016 Deleted items 31200-31215, 31230-31240 31255-31335 Colour Coding for new / updated items: MUCOSAL BIOPSY AND

More information

Patient information factsheet

Patient information factsheet Patient information factsheet Surgery for eyelid cancers What are the aims of surgery? The priority is to completely remove the cancer. Most skin cancers have roots that spread beyond the visible limit

More information

Wound culture. (Sampling methods) M. Rostami MSn.ICP Rajaei Heart Center

Wound culture. (Sampling methods) M. Rostami MSn.ICP Rajaei Heart Center Wound culture (Sampling methods) M. Rostami MSn.ICP Rajaei Heart Center Infection is a major impairment in delayed and nonhealing chronic wounds. Cultures of chronic wounds are not routinely performed

More information

NovoSorb BTM. A unique synthetic biodegradable wound scaffold. Regenerating tissue. Changing lives.

NovoSorb BTM. A unique synthetic biodegradable wound scaffold. Regenerating tissue. Changing lives. NovoSorb BTM A unique synthetic biodegradable wound scaffold Regenerating tissue. Changing lives. Overview NovoSorb BTM is a unique synthetic biodegradable wound scaffold that delivers good cosmetic and

More information

Educational Goals and Objectives for Rotations on: Breast, Wound and Plastic Surgery

Educational Goals and Objectives for Rotations on: Breast, Wound and Plastic Surgery Educational Goals and Objectives for Rotations on: Breast, Wound and Plastic Surgery Goal The goal of the Breast Surgery rotation is to develop the knowledge, skills and attitudes necessary to evaluate,

More information

Pterygium Excision and Conjunctival-Limbal Autograft Transplantation: A Simplified Technique

Pterygium Excision and Conjunctival-Limbal Autograft Transplantation: A Simplified Technique Pterygium Excision and Conjunctival-Limbal Autograft Transplantation: A Simplified Technique Kirti Nath Jha Professor of Ophthalmology Mahatma Gandhi Medical College & Research Institute,Pondy-Cuddalore

More information

Delayed Primary Closure of Diabetic Foot Wounds using the DermaClose RC Tissue Expander

Delayed Primary Closure of Diabetic Foot Wounds using the DermaClose RC Tissue Expander Delayed Primary Closure of Diabetic Foot Wounds using the DermaClose RC Tissue Expander TDavid L. Nielson, DPM 1, Stephanie C. Wu, DPM, MSc 2, David G. Armstrong, DPM,PhD 3 The Foot & Ankle Journal 1 (2):

More information

SKIN GRAFTING FOR THE GENERAL EQUINE PRACTITIONER

SKIN GRAFTING FOR THE GENERAL EQUINE PRACTITIONER SKIN GRAFTING FOR THE GENERAL EQUINE PRACTITIONER Yes you can do it in the field! Sarah J. Waxman, DVM, MS, Diplomate ACVS- LA Clinician in Equine Community Practice Purdue University LEARNING OBJECTIVES

More information

Chest Tube Thoracostomy

Chest Tube Thoracostomy Chest Tube Thoracostomy INTRODUCTION A chest tube thoracostomy is commonly done in the ED to evacuate an abnormal accumulation of fluid (blood, empyema) or air from the pleural space under an elective,

More information

Periocular Malignancies

Periocular Malignancies Periocular Malignancies Andrew Gurwood, O.D., F.A.A.O., Dipl. Marc Myers, O.D., F.A.A.O. Drs. Myers and Gurwood have no financial interests to disclose. Course Description Discussion of the most common

More information

Jadelle Contraceptive Implants up to 5 years Insertion and Removal

Jadelle Contraceptive Implants up to 5 years Insertion and Removal Contraceptive Implants up to 5 years Bayer AG Global HealthCare Programs Family Planning 13342 Berlin, Germany www.bayer.com September 2017 Global HealthCare Programs Family Planning Contraceptive Independence»»

More information

ompanionport Speciality Medical Devices For The Veterinary Community Surgical Suggestions

ompanionport Speciality Medical Devices For The Veterinary Community Surgical Suggestions Speciality Medical Devices For The Veterinary Community suture holes Place the CompanionPort in the subcutaneous port pocket off to one side so that the septum of the port will not lie directly beneath

More information

Home Health Foundation, Inc. To create more permanent IV access for patients undergoing long term IV therapy.

Home Health Foundation, Inc. To create more permanent IV access for patients undergoing long term IV therapy. PROCEDURE ORIGINAL DATE: 06/99 Revised Date: 09/02 Home Health Foundation, Inc. SUBJECT: PURPOSE: MIDLINE CATHETER INSERTION To create more permanent IV access for patients undergoing long term IV therapy.

More information