Skin lump opinion

RE: Skin lump opinion

Anthony Todd — Sat, 16 Nov 2019 16:43:07 GMT

[quote user="Evelyn Barbour-Hill"]As soon as I got into practice I found that everyone put their local through the cut edges. Not sterile? Well, neither is skin.[/quote]

The advice hadn't reached the colonies even by 1962......so we still " sterilised" the skin first.

RE: Skin lump opinion

Evelyn Barbour-Hill — Sat, 16 Nov 2019 16:10:16 GMT

[quote user="Anthony Todd"]I suppose everyone knows, [although I was taught not to], that there is an insensitive area just under the cut edges of a cut [say in a horses leg]. Not sterile they said.....[/quote]

As soon as I got into practice I found that everyone put their local through the cut edges. Not sterile? Well, neither is skin.

RE: Skin lump opinion

Anthony Todd — Thu, 14 Nov 2019 18:34:15 GMT

[quote user="Julian Earl"]unless bothering the dog.[/quote]

Sorry Arlo, and another block coming up, but it may bother the dog but will almost certainly bother the owner and. if it sprays blood on the Farrow&Ball, the blancmange will hit the Kenwood and the vet will be blamed, totally!

And then it be removed......

RE: Skin lump opinion

Julian Earl — Thu, 14 Nov 2019 18:14:27 GMT

I forgot to comment on the image after diverting to the closing of a wound above. Anyway, in that photograph it looks to more like a discharging sebaceous adenoma? Not a particular problem unless bothering the dog. Often , once discharged of contents they seem to diminish away after bursting and sometimetimes then disappear completely. Like a small burst abscess. If persistent then remove. GA or sedation/LA as is appropriate I think.

My thoughts, that's all.

RE: Skin lump opinion

Julian Earl — Thu, 14 Nov 2019 18:08:07 GMT

[quote user="Anthony Todd"]

[quote user="Michael Woodhouse"]Do a lot of stitch ups[/quote]

I suppose everyone knows, [although I was taught not to], that there is an insensitive area just under the cut edges of a cut [say in a horses leg]. Not sterile they said.....

You can get your initial local in there without reaction and follow on with your local as opposed to the initial jab in what always seemed to be a hypersensitive area just where you wanted to lay your sutures.

Interesting to see his. I was not taught this but discovered it for myself and it is a very effective means of introducing local: Injection through the wound surface It sounds counter-intuitive but is very effective and seems far, far more tolerable than pushing a needle through skin adjacent to a sensitive wound. Especially as local anaesthetic seems to sting when injected! Staples are useful in this situation as well. Quick and easy to apply, usually!

[/quote]

RE: Skin lump opinion

Anthony Todd — Thu, 14 Nov 2019 14:12:07 GMT

[quote user="Michael Woodhouse"]Do a lot of stitch ups[/quote]

I suppose everyone knows, [although I was taught not to], that there is an insensitive area just under the cut edges of a cut [say in a horses leg]. Not sterile they said.....

RE: Skin lump opinion

Michael Woodhouse — Wed, 13 Nov 2019 23:56:43 GMT

[quote user="Clive Ansell"]Why do you do under sedation rather than a full GA? not a criticism at all, I'm genuinely curious.[/quote]

Many reasons off the top of my head:

I saw practice somewhere that operated the PDSA scheme with a fixed income and they did a lot of minor ops that way
Nurse can do the whole procedure (can't induce to effect)
More efficient, get out of kennel, IV sedate and get on with the 5 min op. If you faff about with pre-med, waiting to sedate, put a cannula in, induce, tube, wait for apnoea to go, position etc
Cheaper for the owner - we charge less for sedate than GA.
Do a lot of stitch ups of shooting dogs and farmers OOH under sedation and local so we are used to it (debate it all you want but I'll sedate a dog on my own [or use owner to nurse] but wouldn't usually GA).

Saw a dog yesterday afternoon with a wart on its face at the lip commissure. 1cm diameter base, dog kept scratching it and making it bleed. Had breakfast 7 hours ago. Owner willing to wait - signed a consent form, took through the back, IV sedate, clip, clean, bleb of local, couple of stitches and it's walking out with the owner inside 30mins fixed. Nurse did the little op and I nursed as everyone else busy.

It's just so easy. Relatively cheap. Happy owner. Fixed dog.

(I always get permission to GA should it become necessary, I don't remember when it ever was)

RE: Skin lump opinion

Clive Ansell — Wed, 13 Nov 2019 20:01:54 GMT

[quote user="Michael Woodhouse"]I also chop them off and chuck in the bin. Dom/Torb (or suitable generic), bleb of local. Great nurse job.[/quote]

Why do you do under sedation rather than a full GA? not a criticism at all, I'm genuinely curious.

I would not be worried or advise histology either particularly, but tend to give the client the option if they want a belt and braces diagnosis. Some want a cast iron answer.

RE: Skin lump opinion

Michael Woodhouse — Wed, 13 Nov 2019 19:48:37 GMT

I also chop them off and chuck in the bin. Dom/Torb (or suitable generic), bleb of local. Great nurse job.

RE: Skin lump opinion

Beats — Wed, 13 Nov 2019 19:07:00 GMT

I would agree likely benign.

Something else's might include cutaneous horn, cornifying epithelioma or keratinizing cyst?

RE: Skin lump opinion

David Mills — Wed, 13 Nov 2019 08:54:43 GMT

Seen a lot of these. Normally benign harmatoma/sebaceous cyst/something else. Histiocytoma possible but unlikely.

Personally would do in house cytology just to rule out mct then excise, if owners want histo fine but wouldn't be recommending it. Main reason for removal is they can knock the crust off and it can get a bit messy.