The Ophthalmic Office Procedures Handbook

CHAPTER 7

123

Eyelid Biopsy

10. After the lesion is removed, it is set aside on the sterile field either to be discarded or placed in a formalin specimen container. 11. Hemostasis is obtained to stop any bleeding. Some type of thermal cauterization is needed in the office. The high-temperature battery cautery is a perfect instrument to stop bleeding in the office. It is relatively inexpensive. Bipolar instruments also work well but are much more expensive to have in the office. Remember that no supplemental oxygen can be on the field. If near the lash line, be careful of the cautery in its proximity to them. False lashes are also a potential fire hazard. 12. Cauterization shrinks the surrounding tissue, making the defect smaller and will kill most remaining cells. Inflammation alone from the procedure can also kill some of the abnormal cells. Most defects can granulate in over a few weeks, without leaving a significant scar. If sutures are required, use the suture and suture holder to close with interrupted stitches spaced evenly. A 2-loop, 1-loop, 1-loop throw is usually adequate to tie the suture. The 5-0 fast absorbing gut suture usually dissolves in 2 weeks. If permanent suture is used like 6-0 nylon, it should be removed in 7 to 10 days. 13. If the specimen is being sent for pathologic examination, be sure the specimen container is labeled with the appropriate sticker from the pathology sheet as well as the biohazard bag. Place the specimen in the sealed and labeled container into the also labeled, biohazard bag and seal the bag closed. The specimen sheet should be filled out by the office with all pertinent information. The clinician should fill out which lid was biopsied and any perti nent history to help the pathologist. The specimen is now ready to be sent to the pathology laboratory. Most laboratories either will pick up the specimen or have an address where the specimen can be mailed. Incisional Biopsy: Partial Lesion Removal The initial procedure follows steps 1 to 8 as listed earlier under excisional biopsy. With an incisional biopsy, the goal is not to remove every cell of the lesion. The goal might be to re move a portion of the lesion to obtain a histopathologic diagnosis. Once a diagnosis is made, a treatment plan can be recommended. Another reason for an incisional biopsy is to debulk a benign lesion without interrupting the normal architecture or position of the lid. There are two different types of incisional biopsy: shave and punch . Incisional Biopsy: Shave Biopsy (Figure 7-7A and B) This is recommended if the lesion is raised on the lid margin or is a raised lesion along the lash line. The goal is to remove the mass flush with the surrounding normal tissue and to not leave a divot or hollow area. Tissue can still be obtained for diagnosis if needed. The examiner is aware that some remaining cells of the growth may remain, although postprocedure inflammation or cauterization may destroy any remaining cells. This is less invasive than an excisional biopsy and causes less anatomical defects to the lid. 1. Steps 1 to 8 as listed earlier under excisional. 2. If it is a lid margin lesion, a scalpel or scissors is used to cut off the lesion flush with the margin. The tissue is grasped with a forceps. If the lesion is hard to grasp, a chalazion clamp

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