Dermatologic Procedures in Office Practice

 

Description: Now in a convenient and easy-to-use softcover format, Dermatologic Procedures in Office Practice, 2nd Edition, offers clear, step-by-step guidance on the many dermatologic procedures successfully performed in the office setting. This highly visual reference provides full-color photographs and drawings in combination with high-definition, narrated videos to demonstrate key procedures, including the diagnosis and treatment of benign and malignant lesions; cryosurgery; electrosurgery; dermoscopy; excision of skin cancers, cysts, lipomas; and more. The eBook and online videos are the perfect companion when adding a new procedure to your practice.

Features:

Covers in-office dermatologic procedures focused on today’s primary care practice. Uses a concise, step-by-step, bulleted format, including set-up, complication avoidance, pearls and pitfalls, and recovery for each procedure. Features an exclusive online library of more than 100 videos, as well as procedural images and patient photographs, photographs of devices and instruments, diagrams, and medical illustrations throughout the text from expert clinicians. Contains new chapters on Biopsies and Excisions in Challenging Locations (face, ears, nose, genital areas) and Dermoscopy of Other Lesions in General Dermatology. Includes handy appendices with sample consent forms, patient education handouts, and a table recommending when to use various procedures based on the diagnosis. An digital version is included with purchase. The digital allows you to access all the text, photographs, figures, and references with the ability to search, customize your content, make notes and highlights, and have content read aloud.

 

 

Table of Contents:

 

 

 

SECTION ONE. Getting Started

 

1.  Preoperative preparation

Surgical planning

Scheduling of complex surgeries

Preoperative medical evaluation

Medical contraindications

Informed consent

Universal precautions

Medications

Standby medications and equipment

Preoperative patient preparation

Drapes

Sterile technique

Time-out

Conclusion

References

2. Setting up your office: Facilities, Instruments, and Equipment

Lighting

Surgical table, stools, and mayo stands

Hand instruments

Hemostasis

Magnification devices

Personal protective equipment

Injectable medications and chemicals

Equipment

What to have in each exam room

Conclusion

Resources

References

3.  Anesthesia

Topical anesthetics (Figure 3.1)

EMLA for mucosa (Figure 3.2)

Topical refrigerants/cryoanesthesia

Injection technique – see Videos 3.1–3.3

Dental syringes

Adverse reactions

Debunking the myth of epinephrine-induced necrosis

Nerve blocks – see Video 3.4

Field or ring block – see Video 3.5 and 3.6

Pregnancy and lactation

Conclusion

Summary of basic materials needed

References

4.  Hemostasis

Epinephrine – step one

Types of hemostasis

Chemical hemostatic agents

General principles of chemical hemostasis

Electrocoagulation

Electrosurgical equipment and its use

Working in a bloody field

Sterile vs nonsterile procedures

When to use electrocoagulation:

Hemostasis around the eye

Mechanical hemostasis: Pressure and sutures

Buried

Superficial

Oozing on the edges

Using tourniquets, clamps, and instruments to prevent bleeding

Steps to take with nonstop bleeding in surgery

Conclusion

Resources

References

5.  Selecting the right suture

Introduction

Wound healing and sutures

Conclusion

Neck and below

If under more tension (back, shoulders, legs)

Resources

References

6.  Suturing techniques

Basic skills

Specific suturing techniques

Tips for working with fragile skin

Suture removal

Alternative closure techniques

Learning the techniques: Suggestions on how to practice

Conclusion

References

SECTION TWO. Basic Procedures

7.  Laceration repair

Indications for repair

Contraindications for repair

Supplies and equipment

Preprocedure patient preparation

Closure technique

Complications

Postprocedure patient education

Considerations for specific anatomic repairs

CPT/billing codes and ICD-9-CM diagnostic codes

Conclusion

Resources

References

8.  Choosing the biopsy type

General principles

Choice of site to biopsy

Is it cancer?

Considerations for specific anatomic areas

How to do a scalp biopsy

How to submit a specimen to the lab

Margin assessment

Conclusion

References

9.  The shave biopsy

Indications

Contraindications

Advantages of shave biopsy

Disadvantages of shave biopsy

Equipment (Figure 9.9)

Shave biopsy: Steps and principles

Cutting the shave biopsy

Aftercare

Pathology and follow-up

Suggestion for learning the shave biopsy technique

Less than optimal outcomes

Cosmetic results

Making a diagnosis

Additional examples for shave biopsy

Coding and billing pearls

Conclusion

References

10.  The punch biopsy

Indications

Relative contraindications and cautions

Advantages of punch biopsy

Disadvantages of punch biopsy

Equipment

Punch biopsy: Steps and principles

Punch biopsy of a blue nevus (Figure 10.24; see Video 10.6)

Suggestion for learning punch biopsy technique

Complications

Specific examples

Complications

Coding and billing pearls

Conclusion

References

11.  The elliptical excision

Indications

Contraindications

Equipment

The elliptical incision: Steps and principles

Notes on infection

Variations

Alternatives to an elliptical excision

Suggestions for learning the elliptical excision technique

Coding and billing pearls

Conclusion

References

12.  Cysts and lipomas

Epidermal inclusion cysts (EIC) and variants

Surgical considerations for epidermal inclusion cysts (EICs) and pilar cysts (see Videos 12.1 to 12.5)

General considerations for epidermal cyst or pilar cyst removal

Advantages and disadvantages of various approaches

The procedure

Steps and principles for the minimal excision technique (see Video 12-4)

Pathology

Major alternatives

General considerations in treating digital mucous cysts

Needling and cryotherapy of digital mucous cysts

Alternatives

Complications of any cyst removal technique

Lipomas (see Videos 12.7 to 12.10)

Punch (enucleation) technique to remove lipomas

Coding and billing pearls

Conclusion

References

13.  Cryosurgery

Indications

Contraindications

Advantages of cryosurgery

Disadvantages of cryosurgery

Equipment for liquid nitrogen

Cryosurgery: Principles and getting started

Cryosurgery methods

Complications

Treating specific lesions

Learning the techniques see Videos 13.10–13.15

Aftercare

Coding and billing pearls

Conclusion

References

14.  Electrosurgery

Advantages of electrosurgery

Disadvantages of electrosurgery

Electrosurgery versus cryosurgery

Electrosurgery versus scalpel

Equipment

Accessories

Indications for use of electrosurgery

Precautions

Electrosurgical techniques: General principles

Safety measures with electrosurgery

Treating specific lesions

Electrodesiccation and curettage

Learning the techniques

Coding and billing pearls

Conclusion

References

15.  Intralesional injections

Indications

Contraindications

Equipment

Informed consent

Steroid strength

Treating specific lesions

Complications of steroid injections

Intralesional treatments for warts

Intralesional injections for warts due to HPV

Aftercare for all intralesional injections

Coding and billing pearls

References

16.  Incision and drainage

Indications for procedure

Contraindications and cautions

Advantages of incision and drainage

Disadvantages of incision and drainage

Equipment

Procedure: Steps and principles

Aftercare and packing of abscesses

Loop drainage technique

Paronychia

Felon (abscess of the pulp of the distal digit)

Complications of an abscess

Unroofing/deroofing hidradenitis suppurativa

Notes on specific lesions

Special populations

Coding and billing pearls

Conclusion

References

17.  Nail procedures

Overview

Anatomy of the nail unit

Nail procedures

Partial nail plate excision

Destruction of nail matrix

Full nail plate removal (nail avulsion)

Biopsies to diagnose pigmented nail changes (acral melanoma versus benign longitudinal melanonychia)

Notes on other lesions

Complications of nail surgery

Algorithm

Nail plate dermatopathology

Postop directions for patients

Coding and billing pearls

Conclusion

References

18.  Dermoscopy of skin cancer and benign neoplasia

Advantages of and evidence for dermoscopy

Equipment

Algorithms to learn and perform dermoscopy

TADA

Comedo-like openings (Figure 18.7b)

Fissures and ridges (Figure 18.8)

Two-step dermoscopy algorithm for skin cancer criteria

PRP in persons of color

Conclusion

Resources

References

19.  Dermoscopy in general dermatology

Introduction

Inflammatory diseases

Infectious skin diseases

Conclusion

References

SECTION THREE. Advanced Procedures

20.  Biopsies and excisions in challenging locations

Scalp

Periocular

Nose

Ears

Lips

Oral

Genitalia

Sole of the foot (see Videos 20.6 and 20.7)

Conclusion

References

21.  Flaps

Overview

Terminology

Use of flaps following treatment of malignant tumors

Contraindications

Planning the flap

Advancement flap

Advancement flap

Island pedicle flap

Island pedicle flap

Rotation flap

Single rotation flap

Bilateral O-Z rotation flap

Rotation flap

Transposition flap

Rhombic transposition flap

Zitelli bilobed transposition flap

Transposition flap

Learning the techniques

Coding and billing pearls

References

22.  Ultrasound in dermatology

Normal anatomy

Applications

Conclusion

Resources

References

SECTION FOUR. Putting It All Together

23.  Procedures to treat benign conditions

Acne surgery

Acrochordons

Angiomas/angiokeratomas/angiofibromas

Angiokeratomas

Angiofibromas

Chondrodermatitis nodularis helicis

Cutaneous horn

Dermatofibromas

Keloids and hypertrophic scars

Lentigines (solar)

Milia

Molluscum contagiosum

Mucocele

Dysplastic nevi (atypical moles)

Shave

Punch excision

Elliptical excision

Dysplastic nevus (atypical mole)

Congenital nevi

Neurofibromas

Pilomatricoma

Pyogenic granuloma (lobular capillary hemangioma)

Sebaceous hyperplasia

Seborrheic keratoses and dermatosis papulosa nigra

Syringomas

Telangiectasias and spider angiomas

Trichoepithelioma

Warts, common

In-office topicals

Curettage and desiccation

Immunotherapy

Special considerations/billing

Warts, filiform

Warts, flat

Warts, plantar

Warts, venereal (condyloma acuminata)

Xanthelasma

Less common benign adnexal tumors

Conclusion

References

24.  Diagnosis and treatment of malignant and premalignant lesions

Mohs surgery appropriate use criteria (AUC) app (see Figure 27.13)

Actinic keratoses

Squamous cell carcinoma

Keratoacanthoma

Basal cell carcinoma

Melanoma

Clinical appearance

Cutaneous T-cell lymphomas (including mycosis fungoides)

Dermatofibrosarcoma protuberans

Merkel cell carcinoma

Coding and billing pearls

Conclusion

Resources

Selected guidelines

References

25.  Wound care

Wound healing phases

Types of wounds

Pressure injury

Wound care dressings

Wound care

Human amniotic membranes

Prevention of pressure injuries

Treatment of pressure injuries

Special circumstances

Postoperative wound care patient instructions

Special locations

Complications

Conclusion

References

26. Complications: Postprocedural Adverse Effects and Their Prevention

Calling patients to check on them after a large procedure

Responding quickly to patients’ concerns after a procedure

Review of the literature

Clinical management and evaluation of possible infection

Pain

Bleeding

Swelling and bruising

Scarring

Wound dehiscence

Pigmentation changes

Flap necrosis

Nerve damage

Recurrence of a lesion or skin cancer

Making mistakes

Conclusion

References

27.  When to refer/Mohs surgery

Mohs surgery

Appropriate use criteria guideline and a free app

Radiation

Systemic agents for severe forms of BCC and SCC

Referral and systemic therapies for advanced melanoma

Conclusion

References

28.  Coding common skin procedures

Comparing medical work

Biopsies

Destructions of lesions (see Chapters 13, 14)

Shave removal

Excisions (see Chapter 11, elliptical excision, and Chapter 12, cysts and lipomas)

Skin repairs (see Chapter 7, laceration repair, and Chapter 11, elliptical excision)

Incision and drainage (see Chapter 16) (Table 28.11)

Foreign body removal (Table 28.12)

Cosmetic removals

Measure, review, and learn

References

Appendix A.  Consent forms and patient information handouts

Appendix B.  Procedures to consider for benign, premalignant, and malignant conditions

Index

 

An aparitie	iulie 2024
Autor	Richard P. Usatine, Daniel L. Stulberg
Dimensiuni	216 x 276 mm
Editura	Elsevier
Format	Paperback
ISBN	9780323930628
Limba	Engleza
Nr pag	560
Versiune digitala	DA