Dermatologic Procedures in Office Practice
- 2nd Edition - February 20, 2024
- Imprint: Saunders
- Editors: Richard P. Usatine, Daniel L. Stulberg
- Language: English
- Paperback ISBN:9 7 8 - 0 - 3 2 3 - 9 3 0 6 2 - 8
- eBook ISBN:9 7 8 - 0 - 3 2 3 - 9 3 2 3 7 - 0
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… Read more
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Request a sales quoteNow 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.
- 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 eBook version is included with purchase. The eBook 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
Family Medicine
- Cover image
- Title page
- Table of Contents
- Key topics
- Copyright
- Contributors
- Foreword
- Preface
- Acknowledgments
- Video contents
- List of Illustrations
- List of Tables
- 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
- Edition: 2
- Published: February 20, 2024
- Imprint: Saunders
- No. of pages: 560
- Language: English
- Paperback ISBN: 9780323930628
- eBook ISBN: 9780323932370
RU
Richard P. Usatine
Dr Usatine is a Professor of Family and Community Medicine and Dermatology and Cutaneous Surgery, as well as the founder and medical director of the University Health System Skin Clinic in San Antonio. He is the co-author of 10 medical/healthcare books and over 130 articles. He has won numerous teaching awards and loves teaching medical students to become compassionate doctors.
Dr. Usatine has been working with medical students to provide health care to homeless families and the medically underserved since 1984. Dr. Usatine was recognized in 2000 as the national recipient of the Humanism in Medicine Award, by the Association of American Medical Colleges.
Dr. Usatine is involved with numerous national education efforts and is a contributor to the Watch and Learn video library for the Journal of Family Practice Online. Since 2000, he has been chosen yearly by his peers to be included in The Best Doctors in America.
Affiliations and expertise
Professor of Family and Community Medicine, Professor of Dermatology and Medicine, Assistant Director, Medical Humanities Education University of Texas Health Science Center at San Antonio; Medical Director, Skin Clinic, University Health System, San Antonio, TX, USADS
Daniel L. Stulberg
Affiliations and expertise
Associate Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico, USA