Anesthetic Blister Induction to Identify Biopsy Site Prior to Mohs Surgery

May 2015 | Volume 14 | Issue 5 | Editorials | 446 | Copyright © May 2015


Martin Zaiac MD,a Emily Tongdee BS,a Leeor Porges DO,b
Khasha Touloei DO,b Srdjan Prodanovich MD FAADc

aFlorida International University Herbert Wertheim College of Medicine, Miami, FL
bNova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL
cEZDERM, LLC, Naples, FL

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secondary to anesthetic injection can highlight what may be an obscure operative site. The bulla formation induced amongst the weakly adherent malignant keratinocytes allows operation site identification with higher degree of certainty. In our experience and anecdotal data, bulla formation prior to Mohs surgery has increased pre-operative surgical site identification, as evident in our presented surgical case, which was confirmed with frozen sections upon Mohs surgery. Formation of a blister prior to Mohs surgery could therefore be used to help prevent wrong-site surgery.
In conclusion, without confirmation of the biopsy site Mohs surgery should not be performed in order to avoid wrongsite surgery. Rescheduled surgeries may cause lack of patient follow-up and consequently possible medical management neglect and metastasis or growth of tumor.8 Through the use of many available means to confirm biopsy site location, dermatologists can prevent unneeded delay and damage to the patient. As various methods develop and provide assistance in Mohs surgery, we describe preoperative bulla formation as an additional or adjunctive tool to surgical site identification.

DISCLOSURE

The authors have no conflicts of interest.

REFERENCES

  1. Perlis C, Campbell R, Perlis R, et al. Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons. Dermatol Surg 2006;32:79-83.
  2. Starling J, Coldiron B. Outcome of 6 years of protocol use for preventing wrong site office surgery. J Am Acad Dermatol. 2011;65:807-10.
  3. Rossy K, Lawrence N. Difficulty with surgical site identification: What role does it play in dermatology?. J Am Acad Dermatol. 2012;67:257-261.
  4. Perri A, Chan C, Uchida T, Wagner RF. Patients’ recall of visible skin biopsy sites. Skin Cancer. 2008;23: 61-7.
  5. Jawed S, Goldberg L, Wang S. Dermoscopy to identify biopsy sites before Mohs surgery. Dermatol Surg. 2015;40:334-7.
  6. Chuang G, Gilchrest B. Ultraviolet-fluorescent tattoo location of cutaneous biopsy site. Dermatol Surg. 2012;38:479-483.
  7. Lutz M. Surgical pearl: curettage before cutaneous surgery to identify an unidentifiable biopsy site. J Am Acad Dermatol. 2002;46:591-2.
  8. McGinness J, Goldstein G. The value of preoperative biopsy-site photography for identifying cutaneous lesions. Dermatol Surg. 2010;36:194-7.

AUTHOR CORRESPONDENCE

Emily Tongdee BS…................................................... Etongdee@gmail.com
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