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Flashcards in Derm procedures Deck (30)
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1

Describe liquid nitrogen

Destructively cold, clear liquid
-346 F

2

How is liquid nitrogen maintained?

Vacuum sealed container
-Must have pressure relief valve
-Delivered to facility, placed in large storage container, then transferred to smaller containers for daily use, refilled daily

3

Liquid nitrogen MOA

-Destroys tissue
-Causes inflammatory response

4

Process of liquid nitrogen treatment

Freeze - destroy tissue - causes separation - blister - scab - resolution once scab heals (hopefully)

5

Indications for liquid nitrogen

Warts
Skin tags
Seb keratoses
Lentiginies
Actinic keratoses
Early BCC/SCC
*DO NOT FREEZE IF IT NEEDS A BIOPSY

6

Which conditions should NOT be frozen with liquid nitrogen?

Anything that needs a biopsy

7

Downsides of liquid nitrogen treatment

-Hypopigmentation
-Depressed scarring
-Nerve damage
-Incomplete lesion resolution
-Painful

8

Procedure of liquid nitrogen

-Each spot frozen for approx 10 secs
-Freeze 1-2 mm beyond lesion
-Trigger hold (continuous vs. pulsing)

9

If liquid nitrogen tx is near the eye, what should be done?

Cover eye with gauze

10

Post liquid nitrogen expectations

-Area will blister within 12 hrs
-Blister will dry and for a scab in a few days
-Scab will persist 1-2 weeks

11

Post liquid nitrogen care

None needed - ok to wet, no bandage, no abx ointment

12

Where may swelling occur after liquid nitrogen treatment?

Inferior to treatment site (gravity)

13

Follow up for liquid nitrogen therapy

Depends on what you are treating - ALWAYS see pt back if AK/BCC/SCC

14

What is saucerization?

Deeper shave biopsy

15

Define shave biopsy/removal

Superficial removal/biopsy of a lesion

16

Is shave biopsy/removal a clean or sterile procedure?

CLEAN - wear gloves, prep with alcohol and local anesthetic

17

What instruments are used in shave biopsy/removal?

#15 blade on a scalpel handle OR small handheld blade (Dermablade)

18

Shave biopsy/removal should include how much skin?

Include epidermis and uppermost dermis (no deeper than 1 mm)

19

What can be used for hemostasis after shave biopsy/removal?

Aluminum chloride or electrocautery

20

What should be done after taking the shave biopsy/removal?

Apply vaseline or bacitracin and band-aid

21

After care of shave biopsy/removal

-Start 24 hrs after procedure
-Perform daily x 5 days
-Wash w/soap and water
-Apply Vaseline or bacitracin
-Apply band-aid
-Review s/s of infection w/pt
-Let pt know when to expect biopsy results

22

Complications of shave biopsy/removal

-Infection
-Scarring
-Bleeding
-Nerve damage
-Incomplete removal

23

Define punch biopsy/excision

Method of obtaining a specimen at full thickness (all layers) using a punch instrument

24

Indications for punch biopsy

Diagnose lesions, eruptions, hair evaluations

25

Indications for punch excision

Nevi, cysts, dermatofibromas

26

Punch biopsy sizing

-Rash biopsy 4 mm
-Hair biopsy 4 mm
-Cyst removal 6-8 mm

27

Is punch biopsy a clean or sterile procedure?

Clean - wear gloves, cleanse area w/alcohol, use local anesthetic

28

How to remove punch biopsy/excision specimen?

Use needle to pierce it and then cut at bottom of specimen (do NOT use forceps because it may crush tissue making pathology reading difficult)

29

Why shouldn't forceps be used in punch biopsy?

Crushes skin tissue causing difficulty for pathology reading

30

Post treatment of punch biopsy/removal

-Small punches (1.5-2 mm) can be left to heal by secondary intentino
-If larger, close wound by suturing (3 mm punch is 1 suture)
-Vaseline/bacitracin and a pressure dressing