Dermatologic Surgery: Textbook and Atlas by Prof. Dr. med. Johannes Petres, Dr. med. Rainer Rompel, Dr.

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By Prof. Dr. med. Johannes Petres, Dr. med. Rainer Rompel, Dr. Perry Robins (auth.)

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Extra resources for Dermatologic Surgery: Textbook and Atlas

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If tumor is found to extend to the margin of the excision, further excisions are performed in the involved areas. The process is repeated as often as needed to produce a tumor-free wound, which can then be closed using a variety of reconstructive procedures. Many other methods have also been proposed, but our personal experience is principally with the Mohs technique and histographically controlled surgery. Each produces a tumor free site in almost all cases. Rarely, however, the microscopist is deceived either because of technical difficulties with embedding and sectioning, or by tumors with skip or jump regions or long tentaclelike extensions.

We prefer dichlorotetrafluoroethane (Freon 114, Frigiderm) as this has less toxicity than the older agents. The first spray anesthetic was chloroethyl, but this is rarely used today as it may cause hepatotoxity, and if sufficiently vaporized, can be inhaled and lead to systemic anesthetic effects. Furthermore, the mixture of chlorethyl and air is explosive. In addition to cryosprays, cryogels can be employed. These produce enough anesthesia to make injections less painful, but they are rarely used for even the most superficial surgery.

41. Serial excision of a congenital melanocytic nevus a-b First excision and closure after undermining c-f Reexcision 1 year later, with extensive undermining and closure 54 8 Simple Excision and Repair Techniques a c I, , d Fig. 42. 4 Dog-Ear Repair After a wound is closed, swellings or folds of tissue are occasionally created at one or both ends. These folds, called dog-ears, are usually the result of a wound which is too wide for its length or of the opposite sides being of unequal length. Dog-ears are generally corrected by excision; the fold is elevated with a wound hook and then excised with a scalpel, lengthening the wound (Fig.

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