Procedures in general practice

The details of techniques decribed in chapter 24.

• Excisions and other forms of minor surgery are probably best undertaken by a member of the practice who has developed expertise in this area, and received some level of training. It is particularly important to be aware of which lesions and anatomical sites are the most difficult for minor surgery. It is probably wise not to attempt excisions over the sternum and shoulders, particularly in young people, where keloid scars will probably result. In general it is best to refer any malignant lesion to a hospital department for excision.

• Curettage and cautery is a straightforward procedure for the removal of superficial and well defined lesions such as seborrhoeic keratoses and viral warts. It is as well to send all specimens for histology—to confirm the diagnosis and make sure that an unsuspected malignancy is not missed. It is important that a clinical probable diagnosis is made so as to

Demonstration of dressings by liaison nurse
Dressings being applied at home by mother
Mother, liaison nurse, and health visitor discuss treatment

avoid excising lesions where such treatment is not required or when it is inappropriate.

• Cryotherapy is suitable for the treatment of warts, seborrheoic keratoses, solar keratoses, and conditions such as Bowen's disease. If there is doubt as to the diagnosis or the condition fails to respond to treatment a specialist opinion should be sought. It usually most satisfactory to have a cryotherapy clinic for which liquid nitrogen is regularly supplied and a suitably trained nurse is available to carry out the treatment. It is important that all patients are seen by by a doctor before treatment is started so that the diagnosis and suitability for treatment can be confirmed.

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How To Reduce Acne Scarring

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