key: cord-0794561-5du07ywx
authors: Michalski, Basia M.; Lucas, Jennifer L.
title: Avoiding Wrong-Site Surgery in the Era of COVID-19 and Facemasks
date: 2022-01-31
journal: JAAD Case Rep
DOI: 10.1016/j.jdcr.2022.01.012
sha: 4d7c750b8d362e92143e2503ec914f057d3e730d
doc_id: 794561
cord_uid: 5du07ywx

nan

As COVID-19 and its variants persist, universal pandemic precautions (UPPs) remain in place to 23 protect both patients and healthcare personnel. 1 With the implementation of necessary UPPs, 24 dermatologic surgeons now face the challenge of biopsy site identification utilizing photographs 25 of patients wearing facemasks. When worn properly, facemasks hide anatomic landmarks and 26 increase the risk of wrong-site surgery. Herein, we describe a "near miss" case of a patient 27 presenting for Mohs micrographic surgery who had biopsy site photographs while wearing a 28 facemask. 29

A 63-year-old man presented to his dermatologist for a spot of concern on his right nasal 32 sidewall. Physical exam revealed a 3 mm pink papule in that location. A gentian violet marker 33 was used to mark the biopsy site, and a photograph was obtained with the patient's facemask 34 in place ( Figure 1 ). Pathology revealed a basal cell carcinoma, and the patient was scheduled for 35

Mohs micrographic surgery. Four weeks later, the patient presented to the dermatologic 36 surgeon for definitive treatment. The presumed biopsy site was initially marked by a member of 37 the surgical team ( Figure 2 ). Prior to administering anesthesia, photographs from the initial 38 biopsy were printed and utilized by the surgeon to identify the biopsy site. The photograph 39 captured the initial biopsy site of the right nasal sidewall; however, the patient's facemask 40 obscured all anatomic landmarks. The Mohs surgeon noted a pink scar inferomedial to the 41 initially marked site and the referring dermatologist was called to the surgery suite for 42 confirmation. The patient and providers agreed that the biopsy site was indeed inferomedial to 43

Herein represents a case of a "near miss." Even without facemasks, biopsy site identification 48

can present a challenge for providers, especially when photographs are poorly lit, taken without 49 fixed anatomic landmarks, or not taken at all. Risk factors associated with wrong-site surgery 50

include, but are not limited to: miscommunication between members of a team, lack of 51 established safety protocols, poor description of surgical site, dependence on a single provider 52 to correctly identify site, and misinterpreted pre-operative photography. 2 Solutions for 53 avoidance of wrong-site surgeries have been cited in the literature and include: recording 54 measurements from fixed anatomic landmarks, asking the patient to confirm the biopsy site 55 with a mirror, using photography and descriptive biopsy site documentation, asking the patient 56 to take a biopsy site "selfie" if a photograph was not originally taken, and obtaining input and 57 verification from family members. 2,3,4 Finally, as in our case, if the biopsy site remains 58 unidentifiable, the referring physician should be consulted. 3 59 

Avoiding Medical Errors in Cutaneous Site 80 Identification: A Best Practices Review

A schema using fixed anatomic landmarks for biopsy site 82 identification on the head and neck