What is a preoperative dermatologic evaluation?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Answer

The preoperative consultation and evaluation is an important interaction between the patient and the physician. This process allows the surgeon to carefully assess the medical condition, evaluate the patient's overall health status, determine risk factors against the procedure, educate the patient, and discuss the procedure in detail. In return, the patient should gain a realistic understanding of the proposed surgery, consider alternative treatment options, and realize the possible complications during the perioperative period. The additional time invested in a preoperative evaluation yields an improved patient-physician relationship and reduces surgical complications.

The preoperative management of a patient with a surgical problem involves a diagnostic workup, a preoperative evaluation, and the preoperative preparation. The diagnostic workup determines the cause and the extent of the patient's condition. The preoperative evaluation is an overall assessment of the patient's health to identify operative risks that may influence the recovery period. This evaluation includes an anesthetic plan that take into consideration the patient's medical condition, the requirements of the surgical procedure, and the patient's preferences. A thorough assessment ensures that the patient's chronic diseases are under appropriate medical therapy prior to an elective procedure and establishes a rapport and confidence with the patient to allay fears and answer any questions. Finally, the preoperative preparation involves procedures that are implemented based on the nature of the expected operation and the findings of the diagnostic workup and preoperative evaluation.

Many dermatologic surgical procedures are uncomplicated, and extensive patient evaluation is unnecessary. Some of these simple procedures include limited cryosurgery, curettage, electrosurgery, punch and saucerization biopsies, and simple excisions. However, the need for patient evaluation is greater with more complex procedures, such as dermabrasion, hair transplantation, flaps, and grafts. Certain underlying physiologic and pathophysiologic problems demand attention and caution. Medications and dietary supplements are often numerous and need to be scrutinized for their impact on anesthetic agents, hemostasis, and wound healing. With the appropriate preoperative evaluation and precautions, many dermatologic procedures may be safely performed.

For most nonmelanoma skin cancer, a pathologic diagnosis should be established by punch or shave biopsy. For small, low-risk nonmelanoma skin cancer of the head and neck, routine imaging is not usually performed. For larger ones, CT scanning may be the preferred imaging modality, as it allows reasonable evaluation of the extent of ostial involvement (eg, temporal bone, zygoma, maxilla, mandible, orbit), as well as nodal basins. MRI may be used as an adjunct to CT scanning if clinical suspicion for perineural invasion is elevated. Positron-emission tomography scanning generally is not used preoperatively, but rather used to assess the progression of metastatic disease and response to systemic therapy. However, in selected cases, it may be used to assess the extent of regional disease prior to treatment. [1]

 

The goals of this article are to present guidelines for performing a complete preoperative evaluation and to highlight specific issues and management problems that arise in patients undergoing dermatologic surgery.


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