1 Introduction 1
2 Diagnosis 3
Defining the Lesion 3
Studying the Lesion 11
Common Skin Lesions 12
3 Practical Anatomy 23
Relaxed Skin Tension Lines 24
Regional Considerations 26
Superficial Anatomy 30
4 WoundHealing 39
Phases 39
5 Skin Biopsy 47
Incisional versus Excisional Biopsy 47
Shave Biopsy 48
Curette Biopsy 52
Scissors Biopsy 55
Punch Biopsy 55
Excisional Biopsy Technique 58
Special Considerations 58
Biopsy Record Keeping 64
6 Local Anesthesia 65
Chemistry and Classification 65
Local Additives 66
Allergic Reactions 67
Adverse Effects and Drug Interactions 68
Local Anesthesia Technique 68
Topical Anesthesia 72
Tumescent Anesthesia 74
7 Surgical Instruments 75
Scalpels 75
Needle Holders 77
Forceps 80
Skin Hooks 81
Hemostats 82
Scissors 83
Curette 84
Miscellaneous Instruments 85
Instrument Care 86
The Surgical Suite 87
8 Wound Closure Materials 91
Absorbable Sutures 93
Nonabsorbable Sutures 95
Needles 96
Staples 98
9 Patient Preparation 99
Indications 99
Medical History 100
Patient Evaluation 102
Prophylaxis 105
Pacemakers 106
Blood Thinners 107
Dressings 108
10 Basic Excisional Surgery 111
Planning the Excision 111
Marking the Lesion 112
The Ellipse 113
Anesthesia 114
Drape and Preparation 115
Procedure 116
Wound Closure 121
Lazy S Repair 130
11 Surgical Complications 137
Bleeding 137
Infection 143
Necrosis 147
Dehiscence 148
Other Postoperative Problems 149
12 Special Topics in Dermatologic Surgery 155
Melanoma 155
Lentigo Maligna 157
Nevi 158
Skin Cancer 158
Mohs Surgery 160
Cysts 162
Keloids and Scars 163
Lipomas 164
When to Refer 164
13 Risk Management 167
Informed Consent 167
Documentation 169
Confidentiality 171
Appendix Ⅰ Action Guides 173
Skin Biopsy 174
Pigmented Lesions 175
Basal Cell Cancer 176
Squamous Cell Cancer 177
Complications 178
Appendix Ⅱ Vendors for Dermatologic Surgery Suite 179
Index 181