Skin Cancer Removal on Patients Arm
Speaker 1: Hey everyone. So today we're going to remove a large squamous cell carcinoma which is a type of skin cancer ... second most common type.
Speaker 1: This one happened to be a fairly large one. You can see I marked it out already and so it needs to excised and we'll do a layer closure. And I'll take care of it, okay? Alright.
Speaker 1: She's already numbed up and so now I'm cutting a four millimeter margin all the way around it, and that's the standard care for these types of skin cancer. Okay. Okay, gauze ...
Speaker 1: And if you feel anything at all, you let me know. Okay?
Speaker 2: Oh yeah, you'll know.
Speaker 1: Oh yeah. That's right.
Speaker 2: You will know.
Speaker 1: She already warned me she's a screamer, so hopefully this will be easy for her since she's already numbed up. Okay ... There you go.
Speaker 1: So she's actually had this ... She doesn't really remember the length of time but it's around ... she said months. It's hard to know exactly how long it's been around. Okay.
Speaker 1: There's obviously some veins underneath that we'll try to avoid, but we do need to ... this is pretty thick so we do need to make sure that we get it all.
Speaker 1: Can you wipe for me? Nurse [00:02:05] Vanek is going to blot and hopefully [inaudible 00:02:09] catch it. Okay.
Speaker 1: You can see what it looks like underneath the skin here. That's the subcutaneous layer, or the fatty layer, underneath. I'm just kinda checking the margin to see if I can see it. There you go.
Speaker 3: [inaudible 00:02:39].
Speaker 1: Yeah. Okay, then we'll mark than and then we'll send it off to pathology and they will ...
Speaker 1: Check margin. Okay. Now we use a little cautery to cauterize some of the blood vessel.
Speaker 1: Alright, so we need this to come together. We do what's called 'undermining,' and so basically ... Sorry. Basically what it is is we have to loosen the skin around so we can get it to come together. Just like that. Let's see ... a little bit of ... And that should come together nicely.
Speaker 1: Alright. Now we put our subcutaneous sutures, which are sutures that are underneath the skin. And we're using a type that will take about four months to dissolve. Okay.
Speaker 1: See there? We took out a pretty good chunk and you can see we can still get it to come closely together. Okay, okay.
Speaker 1: I cut more of these subcutaneous ... There you go. Okay.
Speaker 3: [inaudible 00:05:20]
Speaker 1: Yeah. Okay. Do you have one of the smaller ... ?
Speaker 3: [inaudible 00:05:35] I can get one.
Speaker 1: It'd be better. Alright. Okay.
Speaker 1: So now it's all together. You can see it nicely ... I'm going to put another layer on the bottom, okay? That's gonna ... let's call our subcuticular layer and that's going to take several months to dissolve. I'm going to put it ... So everything's underneath the skin. We don't have to worry about track marks and that kind of stuff. So it'll look nice.
Speaker 1: The patient won't have to come back for suture removal. It can save a office visit ... and then a lot of patients are just afraid that suture removal would hurt. It really doesn't but a lot of patients fear that. This will take care of it.
Speaker 1: This also will buy another layer underneath that's going to keep the scar from spreading and keep the scar looking nice. I know this particular patient doesn't care about her scar, but some do. Right?
Speaker 2: Right.
Speaker 1: You can see this runs underneath the skin. And you can see her skin is a little thin and fragile.
Speaker 1: Put a nice, pressured dressing on it ...
Speaker 3: Okay.
Speaker 1: Does she have Tylenol at the facility?
Speaker 2: Yep.
Speaker 1: So she's going to take that for ... The patient just takes Tylenol for pain as needed, okay? I would go ahead and give her a couple of Tylenol when she gets there so that way it minimizes the pain.
Speaker 1: Let me just ... So that way I can show ... Here we go. We put a nice, pressured dressing on it. You can see there there's no sutures on top. They will put a little dressing on it and that should heal to a fine line. Okay?
Speaker 2: Okay.
Speaker 1: Thanks everybody.