ODAC Pearls: Top 10 Commandments with Dr. Perry Robins

Dr. Robins’ Ten Commandments presented by Dr. Perry Robins, ODAC Miami 2018

Pearls submitted by Dr. Misty Eleryan

Every physician doing dermatologic surgery should follow these Ten Commandments that Dr. Robins developed in his tenure as a dermatologic surgeon, and has imparted upon his numerous trainees.

1.) Take a thorough history

It’s important to know a patient’s medical history, medications, implanted devices, and results of previous surgeries. This will affect your outcomes and allow you to avoid complications, such as excessive bleeding, increased infection risk, etc.

2.) Curette first

For a derm surgeon, this is the most valuable tool. This removes all of the necrotic tissue and tumor cells and will help you to determine how to proceed with margins.

3. ) Simplest procedure (The “kiss”)

Do the least amount of correction in the maximum amount of time.

4.) Don’t promise “no scar”

Assure the patient that every effort will be made to make the scar as inconspicuous as possible. That is all you can promise. If you make the mistake and promise no scar, you’re sure to have a very upset and anxious patient on your hands in the end.

5.) Two-stage correction

This is the MOST IMPORTANT TIP!!!! First you close the defect, then you bring the patient in 3 weeks to 1 year later to reassess the results. If corrections are necessary at that time, correct it!

6.) Wait and see

Keep your hands off of it! In the case of an unfavorable result, wait and see how it will resolve itself. Wound healing in the third stage starts at 3 months and continues up to 2 years. Oftentimes, nature will do what we did not do.

7.) Photography

Patients will often forget how large the defect was so photographs will remind them. Photographs are good for the referring physician. They are also good for teaching, and helpful when determining if a lesion is new or not.

8.) Call patient at night

Patients may have questions after their procedure, and they will be grateful that you called. It is also a time to confirm their next appointment. Patients will feel that you care and support them.

9.) Truth in advertising

Be careful and be aware of what you hear and see. Some advertisements can be very misleading and have false claims. Don’t fall victim to them. If it sounds to good to be true, it is.

10.) Criteria for good results

Good doctor. Good patient. Good luck.

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