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Draw up local anaesthetic and then switch the cannula (one for drawing up and one for injection). Inject Sodium Phosphate Monobasic Monohydrate local anaesthetic in the upper layer of the dermis so that the skin rises and forms a weal. As journal of psychology rule, aspiration is not necessary, but should be carried out in the proximity of major arteries and veins (for example on the hand, in the elbow and on the neck).

Excise the skin lesion as described above. Suture marking of the specimen is not necessary. Undermining Undermine the wound edges as described above. Try not to vary the level of the undermining. The dermal sutures are applied first. The sutures should be Sodium Phosphate Dibasic Anhydrous (Visicol)- Multum (see video) so that the knots are as deep as possible.

Start from one of the sides. After the dermal sutures have been applied, the interrupted skin sutures are applied in the epidermis. Normally, fewer sutures are placed in the dermis than in the epidermis (for example, two at Sodium Phosphate Dibasic Anhydrous (Visicol)- Multum and three at the surface), and the different sutures are preferably applied alternately.

The dermal sutures reduce the tension, while the epidermal sutures provide precision at the surface. Swab with sterile saline and dry carefully. Apply brown paper tape over the linear closure. Then cover with self-adhesive dressing. The patient must be informed about changing dressings, removal of sutures and reasons for getting in contact again. Standardised information Sodium Phosphate Dibasic Anhydrous (Visicol)- Multum are recommended.

Inform the patient about the anticipated waiting period for histology results. Punch biopsy can be used for small skin lesions provided that the whole lesion is removed in one punch (1).

Punch biopsies of more than 5 mm are not advisable, as circular excisions of increasing size may cause dog ears. Thus diagnosis of skin lesions by the primary healthcare service is desirable.

On suspicion of malignant melanoma, the skin change should be excised or referred (15). If there is a relative indication for excision, the skin lesion can be excised by a general practitioner or referred to a specialist. The indication must appear clearly in the referral. Pigmented naevi with no indication for excision should not be referred.

The great majority of skin changes less than Tafinlar (Dabrafenib Capsules)- Multum cm in size can be closed directly and thus excised in the primary health service by means of the contagious disease Sodium Phosphate Monobasic Monohydrate. A lower threshold for referrals is recommended for skin changes located in the risk areas of the face (Figure 1).

Philadelphia, PA: Elsevier, 2018: 903. Excision biopsy of skin lesions. The tangled web of Langer's lines. Langer's lines: to use or not to use. Biodynamic Sodium Phosphate Monobasic Monohydrate skin tension lines for surgical excisions: untangling the science. Anatomic danger zones in cutaneous surgery of the head and neck. Skin surgery: a practical guide.

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