How is the lesion location assessed during the dermatologic preoperative evaluation?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Several methods can be used to describe the location of the lesion. One method is to measure from 2 distinct landmarks. Physicians may also use the New York University numbering system, which uses standardized numbers assigned to anatomical regions for consistent identification. Photographing the lesion provides the most accurate description (digital imaging). Digital imaging and archiving simplify follow-up. [22] See Digital Photography for detailed information.

Awareness of anatomical structures residing close to the intended surgical field is essential. A thorough understanding of vascular networks, neural innervation, and structural anatomy is needed. For example, the head and the neck are frequent domains for the cosmetic surgeon. Here is where many cutaneous malignancies occur and cosmetic enhancements are performed. A surgeon should appreciate that the external carotid artery supplies most of the face. From this artery, the superficial temporal artery is amenable to injury as its course becomes superficial en route from the preauricular region to the scalp. This branch can often be easily palpated and its location noted prior to embarking on surgery. Likewise, the inferior and superior labial branches of the facial artery are frequently encountered during lip surgery. If anticipated, these vessels can be suture ligated to avoid excessive bleeding when performing wedge excisions.

The facial nerve (5 branches: temporal, zygomatic, buccal, marginal mandibular, and cervical) is responsible for motor innervation to the face. Of these branches, the temporal and mandibular branches become superficial during their course and are subject to damage during surgery. Injury to the temporal branch results in ipsilateral eyebrow ptosis and paralysis of the frontalis muscle (inability to wrinkle the forehead on the affected side). The marginal mandibular nerve, if injured, results in drooping of the lower lip. These potential occurrences should be discussed with patients in advance of their procedure. Surgeons must always be alert to these and other "danger zones."

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