Surgical Workshop: Clinical Pearls

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

What are some important pearls when performing surgery?

  1. Have patient take a “selfie” to identify biopsy site for future reference;
  2. 
Eliminating standing cones by placing lateral sutures will create an elegant biopsy scar;
  3. Know the anatomy prior to performing a biopsy or excision at the head or neck;
  4. Hold scalpel like a pencil at 90° angle to the skin;
  5. Excise to a uniform depth throughout the wound.

Core Principles of Surgery: Clinical Pearls

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

What are the key takeaway points with regards to surgery?

  1. Anticipate persistent ooze with NSAIDS;
  2. Anticipate aggressive lesions in OTRs & CLL patients;
  3. Prep surgical field much wider than anticipated;
  4. HibiClens is potentially ototoxic and occulotoxic; consider iodine prep;
  5. Increase patient comfort by injecting buffered lidocaine intradermally first, then injecting dermal tissue;
  6. Beware of high-risk sites (temple, jaw, lateral neck);
  7. Patients will lose/ forget/ ignore wound care instructions; plan accordingly;
  8. Provider will lose a sample/ forget to communicate a result/ ignore a surgical complication at some point; prepare accordingly.

Clinical Pearls: Dermoscopy

Ashfaq Marghoob, MD

Dr Marghoob, an expert in dermoscopy, provides us with key takeaway points from his workshop at Maui Derm NP+PA Summer…

  • Shiny white structures seen with polarized dermoscopy are important clues for malignancy
  • The key features seen in malignancy: dermoscopic asymmetry, blue-black-gray color, shiny white structures (includes negative network), and blood vessels
  • Never monitor palpable lesions unless you know for sure they are benign
  • Shiny white blotches and strands is a new criterion for BCC
  • The 2-step algorithm, pattern analysis, 3-step algorithm, chaos and clues and the AC rule can be condensed into the TADA algorithm.

New Drugs-Pediatric Style

Sheila Fallon-Friedlander, MD

Dr Friedlander provides us with her clinical pearls on new drugs–pediatric style…

  • Propranolol has revolutionized the treatment of problematic infantile hemangiomas
    • The most common side effect is sleep disturbance; next acral cyanosis
    • Hypoglycemia can occur but unlikely if baby is eating appropriately
    • The drug can be given BID
    • Infants with large segmental hemangiomas should be evaluated for PHACES prior to instituting propranolol therapy
  • Timolol is highly effective for superficial hemangiomas & can obviate the need for systemic therapy
  • Nadolol is a beta blocker which does not cross the blood-brain barrier; it can be useful in kids with CNS effects (e.g severe sleep disturbance)
  • Rapamycin is useful both systemically & topically in the treatment of disorders involving the mTor pathway
  • This includes Tuberous Sclerosis, Lymphatic malformations, and some mixed veno-lymphatic abnormalities