Tip 1: Managing a BCC
I recommend the following tip to residents to use after they have performed a shave biopsy on a suspected basal cell carcinoma (BCC):
- Most often after I shave off a rather obvious BCC, I use a curette to scrape the underlying post-shave site to see if there is any residual friable BCC tissue remaining either deeper or surrounding the site. This helps me decide whether a lesion may require further surgery or Mohs surgery. I think it is a good way to know how to plan further therapy and inform the patient about it.
Herb Goodheart, MD
Elmhurst, New York
Tip 2: Spotting Potential Problem Cosmetic Patients
After years in clinical practice, I have identified some characteristics and situations that often are precursors to an experience with a dissatisfied or problematic cosmetic patient. They include:
- Unrealistic expectations
- Rude patients
- Overly flattering patients
- Overly familiar patients
- Sudden whim patient
- Minimal of imagined deformity—the body dysmorphic disorder patient
- Very important patient (VIP) or “holier than though”
- The physician shopper— “I’ve seen 5 other cosmetic doctors before you”
- Patient involved in litigation against physicians in the past
- Patient who puts down other physicians and/or inappropriately or overly praises you
- Too many phone calls or too many no-shows to your office
- Uncooperative patient
- Price-haggler/let’s make a deal!
- Gut feeling of dislike about the patient or your staff dislike the patient
- Patient has major event within 1 week of wanting treatment
Benjamin Barankin, MD, FRCPC
Toronto, Ontario, Canada
Tip 3: Environmentally Conscious
We have vests and drapes for our patients. They usually keep their underwear on. We do not automatically give every patient a drape and/or vest. We ask and oftentimes men do not want a drape or vest; some women prefer a drape only. We always ask as a way not to waste paper.
Jane Chew, MD
Tip 4: Tumescent Anesthesia Benefits
Tumescent anesthesia is useful not only to stretch the skin, but it also diminishes bleeding and eases visualization of vessels and nerves in areas such as the forehead and temples. I use 1% lidocaine for intravenous injection (this preparation can even be used intrathecally). It is not irritating, and the low concentration of lidocaine prevents “-caine” systemic toxicity. Volumes employed usually range from 15 to 20 mL subcutaneously. I inject some superficially to hasten anesthesia.
Mauricio Goihman-Yahr, MD
Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.