The Ophthalmic Office Procedures Handbook

CHAPTER 7

127

Eyelid Biopsy

VIDEOS OF PROCEDURES Video 7-1 —Excisional biopsy: lash line and periocular lesions. Excisional biopsy: This patient has two lesions to be removed, a lateral exophytic lesion away from the eyelid margin and a medial lid margin lesion close to the inferior punctum. Informed consent was already obtained, and the form was signed and witnessed. The patient was placed in a supine position, and topical anesthetic oph thalmic drops were placed in the eye. An ice pack was placed on the lid for 2 to 3 minutes. The peri ocular area was cleaned with the povidone–iodine solution. Local anesthetic was injected into the lid using a 30-gauge needle around both lesions. Using a toothed forceps in one hand, the lesion is grasped, and the base is cut using a Westcott scissors in the other hand. The base of the lesion is then cauterized with a handheld high-temperature battery cautery. The lesion has been excised. Video 7-2 —Incisional biopsy/shave: lid margin using chalazion clamp. Lid margin/shave biopsy: This patient has a flat, pigmented lesion of the upper eyelid. Consent was obtained, and the form was signed and witnessed. An ice pack was placed on the lid for 2 to 3 minutes. The area was cleaned with a povidone–iodine solution after topical ophthalmic anesthetic drops were placed in the eye. Local anesthetic was injected into the area of the lesion using a 30-gauge needle. A chala zion clamp is placed to protect the eye and to help with hemostasis. The lesion is incised at the edge of the lesion with a scalpel, and the lesion is shaved off the margin. Because some residual tissue is still attached, the clamp is removed and a toothed forceps is used to grasp the lesion. The Westcott scissors are used to cut the lesion completely off the lid. Hemostasis is obtained with a handheld high-temperature battery cautery with great care not to cause a notch or divot in the eyelid margin. The specimen was sent for histopathologic diagnosis. Video 7-3 —Shave excision of eyelid skin lesion using a No. 11 surgical blade under local anes thesia. (Video courtesy of Leonid Skorin, Jr. and Scott A. Bauer.) Video 7-4 —Excision of actinic keratosis eyelid skin lesion under local anesthesia. (Video courtesy of Leonid Skorin, Jr. and Kynndyl Giannonatti.) Video 7-5 —Excision of seborrheic keratosis, maxillary skin lesion under local anesthesia. (Video courtesy of Leonid Skorin, Jr. and Kynndyl Giannonatti.) Video 7-6 —Excision of squamous papilloma, medial canthus. Healing by secondary intention. (Video courtesy of Leonid Skorin, Jr. and Andrew Krein.) Video 7.7 —Shave excision of eyelid margin lesion using a No. 11 surgical blade under local an esthesia. (Video courtesy of Leonid Skorin, Jr. and Laura Goemann.) EFFICACY The ability to obtain an accurate histopathologic diagnosis is very high with incisional or ex cisional biopsy. Because incisional biopsy has slightly more accuracy than a punch biopsy, it is recommended over a punch biopsy in an atypical lesion. The reoccurrence rate is low with an excisional biopsied lesion where the margins are clear of any irregular or atypical cells. However, as stated previously, the goal of removing a benign lesion is to remove as much as possible of the abnormal cells without distorting the anatomy or causing a noticeable change to the lid or lid position. Therefore, the incidence of reoccurrence of benign lesions is higher in a shave biopsied lid lesion than in an excisional biopsied lesion.

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