Skin And Soft issue Lesions - Standard Treatment Guidelines

Ministry of Health and Family Welfare, Government of India has issued the Standard Treatment Guidelines for Skin And Soft issue Lesions. Following are the major recommendations :

Name of the condition : Skin and subcutaneous lesions

When to suspect/ recognize?

1. Introduction: There are a large number of skin and subcutaneous lesions, both benign and malignant. The aim of the surgeon is to identify those which are malignant or carry malignant potential and institute appropriate treatment.


2. Case definition: All lesions identified clinically as occurring in skin or subcutaneous tissue.

Incidence of the condition in our country: The condition is very common. However, the exact incidence is not reported.

Differential diagnosis:

Prevention and counseling : Specific to each lesion

Optimal diagnostic criteria, investigations, treatment and referral criteria:

Situation 1 At Secondary Hospital/ Non-metro situation: Optimal standard of treatment in situations where resources are limited

Clinical diagnosis: Based on clinical features specific for each lesion.

Investigations:

1. FNAC


2. Incision biopsy (for larger lesions)


3. Excision biopsy (for smaller lesions)

Treatment (Standard operating procedure)

1. Inpatient: Not indicated


2. Outpatient/ Day care: These lesions can be treated on day care or outpatient basis. All lesions do not need treatment.

1. Confirm diagnosis by investigations


2. Excise the lesion under LA with appropriate margin.


3. For large lesions or in children general anesthesia may be used.


4. Skin is closed by primary suturing/ grafting.

Referral criteria: Not indicated.

Situation 2 At Superspecialty Facility in Metro location where higher end technology is available:

Clinical diagnosis: Based on clinical features specific for each lesion.

Investigations:

1. FNAC


2. Incision biopsy (for larger lesions)


3. Excision biopsy (for smaller lesions)

Treatment (Standard operating procedure)

1. Inpatient: Not indicated


2. Outpatient:


3. Day care:

Referral criteria: Not indicated.

Who does what and timelines

Doctor:

Clinical diagnosis, investigations and treatment

Nurse:

Assisting the surgeon in investigations and treatment

Technician:

Assisting in investigations and treatment

Guidelines by The Ministry of Health and Family Welfare :

Dr Sanjay Gupta Professor, Department of Surgery University College of Medical Sciences, Delhi