biopsy

was scheduled to meet dermatologist at RAH, reffered by Dr from unihealth, former known as parklands.

clock is ticking, its nearly 2pm. the appointment is at 215pm. should i go now? as i’m about to pack-up, Dr Ortho starts explaining about today’s activity. now, how im going to make through the door? As he finished, i got up and left the room. noted that i already told him i have to leave early for hospital today…

walking towards outpatient building from dental hospital is just 5 minutes away…i tried to call outpatient counter, No Answer! tried twice, nahh dont bother the trice. reached the counter, its 225pm. “i know i’m late for 215 appt. sorry abt that, i’ve got class” “no worries love!”. “come with me to the clinic”… now? ..yeah, come along… this is fast! alhamdulillah.

after checking the black lesion spot on my forehead, she decided to do biopsy. its not cancer or anything, syukur! alhamdulillah! err Dr, what is biopsy? “its a procedure to scrap a layer of your skin to be tested. dont worry, it is just a minor surgery, i’ll give you LA to numb the area” Whooa! ya Allah, is this for real? me, by myself,? here, in this room,? now, need small surgery? O Allah, please help your servant!

it happened so fast. didnt feel a thing. accept for the ‘sting’ feeling when LA being injected into my head..hope that LA last forever, but it didnt. while eating for iftar, it starts to hurt. LA effect had gone. Ouchh! i could still feel it till now.. The nurse said it’ll be fine after 2days…. inshaAllah 🙂

in a week time, biopsy result!

for the mean time…to know more about biopsy, cut&paste from virtualmedicalcentre

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Skin Biopsy

A skin biopsy is simply the removal of a small sample of skin tissue so that it may be sent off to the lab for further investigations which can reveal many useful things about the lesion and can change the future management. This article answers some general questions such as:

• What is a Skin Biopsy?
• Why do a Skin Biopsy?

As well as discussing the various types of skin biopsy:

• Shave Biopsy
• Punch Biopsy
• Surgical Excision

(only going to share about Surgical Excision here..as thats what i’ve been through)

What is a Skin Biopsy?

A skin biopsy is basically a very small sample of skin that is removed by a doctor so that it can be examined in a lab to determine what cells it is made up of. Skin lesions (lumps, bumps and other changes) are very common things for a person to present to their GP with. While many of these are harmless, they can be cosmetically displeasing and many have the potential (however unlikely) to develop into something more serious. As such, all skin lesions should be investigated or removed if the general practitioner has concerns about it.

For many skin lesions, such as skin cancers, the first treatment is surgical removal. This is because it does not only provide a definitive diagnosis, but is also the most effective treatment. For some lesions however, it is necessary to take a small sample of the tissue before proceeding with treatment. The name for these ‘small samples’ is a biopsy, and so a skin biopsy is just a small sample of skin that is removed and sent to a lab for further analysis.

Why do a Skin Biopsy?

A skin biopsy may be done because the treatment will be very different depending on what the lesion turns out to be, or it may be that the doctor has to be very sure it is worth removing, such as if removal would require extensive surgery on a sensitive area such as the face.
The information that can be obtained from a skin biopsy would include things such as what type of tumour or problem is within the lesion, what types of cells make up the lesion and how they look, as well as confirming that all of a tumour has been removed.

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Surgical Biopsy

A surgical biopsy is often the first step for a skin lesion, as it provides both a very good method of diagnosis along with actually being one of the most effective treatments. Sometimes a surgical biopsy can remove the entire lesion, and this is called an ‘excisional’ biopsy. Other times, only part of a lesion may be removed so that it can be sent to the lab for further diagnostic tests and this is called an ‘incisional biopsy’.

There are several reasons for a surgical biopsy:

• basal cell carcinomas and squamous cell carcinomas can be very effectively treated with a complete surgical excision.
• Removal of pigmented lesions can both identify melanomas as well as get information regarding its depth.
• Almost any lesion that cannot be adequately assessed or treated by punch or shave biopsy often requires a surgical biopsy.

What Happens During a Surgical Biopsy?

Firstly, the doctor will want to very closely examine the lesion to see just how big it is, whether it is a small lump or is irregular etc. so that they have a very good idea what needs to be removed. As this is a surgical excision, the area will be cleaned with some surgical-strength cleaning agents such as chlorhexidine or iodine, and usually a surgical drape (which can be plastic or cloth) will be placed around the site.

Next, the doctor will probably (but not always) draw out the area that needs to be removed. The best shape for a cut is an ‘ellipse’, although actually it’s not a true ellipse because it is pointy at both ends. This shape allows for the best healing. Usually the ellipse will be about 3 or 4 times as long as it is wide. The general shape and usual features of the cut are seen in the diagram to the right.

The ellipse is usually placed so that the longer length runs along the skin creases. This is because the skin creases mark out areas that are under lower tension, and so there will be less stress on the wound afterwards causing a better outcome with less pain and scarring.

Following marking out the area, it will be infiltrated with a local anaesthetic until suitably numb. The skin will then be cut using a scalpel, following the markings. This will be cut down to the layer below the skin – the subcutaneous (which means literally, ‘below the skin’) fat. This will form a little ‘island’ of skin that is completely separate from the area around it. This ‘island’ will be lifted up with some forceps and a scalpel will cut away any connections. Of course, due to the anaesthetic, you will not be able to feel any of this. This sample will then be taken away, put in a fixative and sent off to the lab.

At the lab, they take very fine slices from the lesion, add some special dyes so that the different types of cells stand out, and then put the sample under a microscope (they do this with the other biopsy samples as well). While the resulting slide may look very confusing, to a trained eye it reveals many things. An example slide (with some features pointed out) is shown below.

After the lesion has been removed, the doctor will put in some stitches. They may put in a stitch that sits below the skin which dissolves: this stitch helps to stop bleeding and prevent the formation of a ‘haematoma’ (a collection of blood beneath the skin). Some doctors use an antibiotic ointment over the site, however this is not necessary to obtain adequate healing. After this, a dressing will be placed over the area, and it’s all done!

Removal of the sutures will depend on the site in which they have been placed. In areas with significant skin tension like the back, they may be left in place for up to 2 weeks, whereas in more delicate areas such as the face and hands, they can often be removed after as little as 5 days.

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okay..thats it for now…i’ll share the result next week inshaAllah…

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lets work harder to gain/meet LailatulQadr..holy nite of Ramadhan, to attain the best of Allah bless and forgiveness