PCSS - Primary Care Surgical Services

21/04/2025

07/06/2024

22/12/2021

Last No-Scalpel Vasectomy review before Christmas! Ho ho ho! 🎅

Wishing everyone a very Happy Christmas and hope you and your family have a good one! 🎄

21/10/2021

5️⃣years ago today - Primary Care Surgical Services performed its first No-Scalpel Vasectomy! ✂️✂️

The 1st photo shows the very first feedback received - 21/10/2016; while the 2nd photo was the most recent - 20/10/2021.

Since half a decade ago (and 500+ vasectomies later), while the location of PCSS may have changed, it is good to know that patient feedback continues to remain positive!! 👍👍

If you have completed your family, and are thinking of a safe and efficient form of long term contraception, visit pcss.ie or ☎️ 056-7764666 for more information.

07/10/2021

This 82 year old lady attended PCSS with a 1 year history of a growth on the skin of her right arm. This skin lesion had been increasing in size and causing some discomfort, as it was catching on her clothes.

🔍Examination of the posterior (back) aspect of her right arm showed a raised, pale, skin lesion that measured 1cm in diameter, with some prominent superficial blood vessels and central ulceration noted (Photo 1).

This lesion was removed via a longitudinal elliptical excision 🔪, the wound sutured
🪡 (Photo 2) and the skin lesion (Photo 3) was sent to the histopathology lab for assessment 🔬.

What do you think was removed?? 🤔🤔
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1️⃣
➡️The histopathology result of this lesion returned showing a ‘well differentiated squamous cell carcinoma with keratoacanthoma-like features’ and was ‘fully excised’. 😄

⭐️MORE FUN FACTS⭐️
1. As mentioned before, squamous cell carcinomas (SCCs) of the skin are the 2nd 🥈 most common form of skin cancer, and commonly occur on areas of skin that have been exposed to the ☀️.
2. Some people might wonder why a large/long wound is required for an excision of a somewhat smaller SCC… 🤔
➡️ The reason for this is that a margin of normal looking/clear skin around the lesion is required to ensure that the SCC is fully excised, otherwise there is a higher risk of recurrence in that region.
3. A keratoacanthoma is a dome-shaped skin lesion that also occurs in areas of skin with 🌞 damage, but usually grows much quicker and can cause pain, and may resemble a boil initially. While it usually resolves by itself 👏 over time, there is a chance that it can develop into a SCC 🙁, so it would be wise to consult your GP or Dermatologist about it!

🌟 TAKE HOME MESSAGE! 🌟
If you notice a new or unusual skin lesion that is increasing in size or changing over time, do contact/visit your GP or Dermatologist for further assessment. 👩‍⚕️ 👨🏻‍⚕️ 🧑🏽‍⚕️

30/09/2021

‼️A THURSDAY TIDBIT‼️

This 44 year old man was referred to PCSS with a >6 month history of a skin coloured swelling on his left arm, that has been slowly increasing in size over time, and causing some discomfort when it gets caught on clothes etc.

On examination, there was a raised, pedunculated (attached on a stalk) skin coloured growth on the upper antero-medial (front and inner) aspect of his left arm. This lesion was compressible (squidgy) and was non-tender on palpation (Photos 1 & 2).

This lesion was excised using electrocautery⚡️that was applied to the base of the stalk, where it met the skin, leaving a residual scab where it had been (Photo 3).

What might it be?? 🤔

Scroll down for the answer…
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Answer - SKIN TAG (AKA FIBROEPITHELIAL POLYP, AKA ACROCHORDON)

Photo 4 shows the excised skin tag!

🎈 FUN FACTS ABOUT SKIN TAGS 🎈
1. Skin tags are common skin lesions that usually arise around the neck, eyelids, axillas (armpits) and groin regions, but can be found anywhere on the body.
2. They are benign skin tumours that do not turn cancerous 😀, but can grow in size over time, sometimes becoming quite large requiring a more extensive surgical procedure.
3. While there is equal prevalence in women women and men, skin tags tend to be more frequently found as we age, occurring in up to 64% of people aged 50 years and older.

🌟TAKE HOME MESSAGE!🌟
While skin tags are not hazardous to your health 😃, they can cause irritation and discomfort depending on their location 🙁 ie. skin tags on neck catching on chains/necklaces, or rubbing/chafing off collars of clothes.
Some skin tags can grow quite large and unsightly, also causing discomfort and can be cosmetically annoying.
Most skin tags can be treated using either cryotherapy/cryosurgery (use of liquid nitrogen causing a freeze burn 🧊🥶) or cautery/diathermy (use of a device that generates heat, once again causing a heat burn 🔥🥵), however, larger skin tags may require surgical excision 🔪 instead!

***Patient has given consent for use of these photos***

23/09/2021

⚠️ WARNING - if you’re SQUEAMISH! ⚠️

This 49 year old man attended PCSS with a 3 month history of swelling at the occipital region (back) of his head, that has been increasing in size over time, and causing some discomfort.

On examination of this area, there was slight redness of the overlying skin, and on palpation, a slightly mobile subcutaneous swelling was noted, which was non-tender (Photo 1).

A vertical incision 🔪 was made over the swelling and this lesion was removed, and the wound 🪡(Photo 2).

What might it be?? 🤔

Scroll ⬇️ for the answer…
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Answer - A PILAR CYST (OR TWO!)
Photo 3 shows the first cyst being teased out with applying pressure on the skin around it.
Photo 4 shows the ✌️cysts, attached by some connective tissue.

⭐️ FUN FACTS ABOUT CYSTS ⭐️
1. Pilar cysts are common lesions that can be found in areas of the body that have hair - usually the scalp.
2. These cysts are made up of a sac, that is filled with a fluid/semi-fluid 🧀-looking material that is made up of soggy keratin, a type of protein that is found in hair, nails and skin.
3. Sometimes, these cysts can pop by themselves when they get too big, or from trauma ie. combing, brushing, scratching, and you can expect some discharge of its foul-smelling contents! 👃☹️

TAKE HOME MESSAGE! 👇👇
While most pilar cysts are small and not bothersome, sometimes they may require removal, and indications for this are:
INCREASING SIZE/DISCOMFORT - cysts can increase in size over time, and can discomfort/pain due to its size and position
INFECTION - cysts can also become infected occasionally, requiring antibiotics to treat the acute infection, and some people may get recurrent infections
COSMETIC - they can be unsightly, and can cause hair loss of the overlying scalp skin when it becomes larger

***Patient has given consent for use of these photos***

16/09/2021

This 69 year old lady self referred herself to PCSS with a 6 week history of a new onset left arm skin lesion that was increasing in size over time, becoming increasingly crusty on the top and causing some discomfort. She denies any bleeding or pain.

🔍 Examination of her left arm showed a 9mm x 14mm raised, ovoid, pale nodule with a central area of ulceration, which was non-tender and firm to touch/palpation (photo 1️⃣).

A longitudinal elliptical excision was performed (photo 2️⃣) and the excised lesion was marked with a suture 🪡 , indicating the 12 o’clock position (photo 3️⃣).

The lesion was sent to the histopathology lab for further assessment 🔬, the results of which showed a ‘well differentiated squamous cell carcinoma’ that was ‘completely excised’. 😃

Follow-up at Day 12 post-surgery shows a clean healing wound after removal of sutures (photo 4️⃣). 😃

RANDOM FACTS! 👇
1. Squamous cell carcinomas (SCCs) of the skin are the 2nd 🥈 most common form of skin cancer, and are locally invasive non-melanoma cancers.
2. SCCs commonly occur on areas of skin that have been exposed to the ☀️ - head, face, neck, back and limbs - but can also occur in other areas of the body.
3. The majority of SCCs can be treated easily and successfully when caught early, but if left to grow, can cause disfigurement and can become invasive, spreading to deeper layer of skin and may even spread to other parts of the body! 🧐

🌟 TAKE HOME MESSAGE! 🌟
If you notice a new or unusual skin lesion that is increasing in size or changing over time, do visit your GP or Dermatologist for further assessment. 👩‍⚕️ 👨🏻‍⚕️ 🧑🏽‍⚕️

***Patient has given consent for use of these photos***

09/09/2021

This 85 year old man was referred by his GP to PCSS with a 6 month history of a new onset left face lesion that was increasing in size over time and non-healing. He reports some intermittent bleeding due to trauma from shaving, but denied any unprovoked bleeding, scabbing or pain.

Examination of his left face/cheek region showed a 7x6mm raised, circular, red skin lesion that was firm to touch/palpation. It was non-tender. On closer examination, there were some arborising (tree-like) blood vessels noted on the surface of the lesion.

An elliptical excision was performed and the lesion was sent to the histopathology lab for further assessment. The results returned showing a nodular ‘basal cell carcinoma, completely excised’.

Photos 4 & 5 at Day 6 post-surgery shows a clean healing wound, and sutures were removed with ease.

RANDOM INFO ⬇️
1. Basal cell carcinomas (BCCs) are the most common form of skin cancer, and are locally invasive non-melanoma cancers.
2. BCCs have a tendency to erode into the deeper tissues over time, thus given them the name of a ‘rodent ulcer’.
3. There are several subtypes of BCCs, and the ‘nodular’ type is the most common type - accounting for up to 80% of BCCs and most often occur on sun-exposed areas of skin i.e. head, neck, upper limbs and back.
4. Facial wounds generally heal very well, due to the face and scalp having a very good blood supply. As such, wounds heal quickly and sutures/stitches in these regions can be removed at 5-7 days post-op.

⭐️TAKE HOME MESSAGE⭐️
BCCs can be completely curable when diagnosed and treated early, with a good prognosis of 💯% survival rate, if it has not spread to other areas. 😀

However, if left to grow and progress, BCCs can result in substantial morbidity and cosmetic deformity, even with treatment.🙁

⚠️If you notice a new skin lesion that is increasing in size/changing over time, do visit your GP or Dermatologist for further assessment.⚠️

***Patient has given consent for use of these photos***


ie

case

29/08/2021

A 68 year old man was referred to PCSS by his own GP with a 3 month history of a new onset right forearm skin lesion that had increased in size over time, becoming raised and non-healing.

Of note, he has a history of 🌞 exposure over time, having worked outdoors for many years.

Examination showed a 1cm diameter raised nodular lesion, rolled edges and central ulceration.

An elliptical excision 🔪 was performed and tissue sample sent for pathology - showing a basal cell carcinoma, that was completely excised.

SOME QUICK INFO:
➡️Basal cell carcinomas are common, locally invasive non-melanoma cancers, and are the most common form of skin cancer.

Some risk factors for developing them are:
Age/sex - more prevalent in the elderly; males > females; but can be present in younger adults
Sun exposure - previous sun damage and repeated prior episodes of sunburns
People with fair skin, blue eyes, fair hair ie. blond/red
Previous history of skin cancers

TAKE HOME MESSAGE ⬇️
If you notice any new skin lesion that was not there before, or an existing skin lesion that has changed, it would be advised to consult your GP or Dermatologist.

***Patient has given consent for use of these photos***


ie