Breast Self-Exam

A breast self-exam is a check-up a woman does at home to look for changes or problems in the breast tissue. Many women feel that doing this is important to their health.

However, experts do not agree about the benefits of breast self-exams in finding breast cancer or saving lives. Talk to your health care provider about whether breast self-exams are right for you.

Information

The best time to do a monthly self-breast exam is about 3 to 5 days after your period starts. Do it at the same time every month. Your breasts are not as tender or lumpy at this time in your monthly cycle.

If you have gone through menopause, do your exam on the same day every month.

Begin by lying on your back. It is easier to examine all breast tissue if you are lying down.

• Place your right hand behind your head. With the middle fingers of your left hand, gently yet firmly press down using small motions to examine the entire right breast.
• Next, sit or stand. Feel your armpit, because breast tissue goes into that area.
• Gently squeeze the nipple, checking for discharge. Repeat the process on the left breast.
• Use one of the patterns shown in the diagram to make sure that you are covering all of the breast tissue.

• Next, stand in front of a mirror with your arms by your side.

• Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel.
• Also note the shape and outline of each breast.
• Check to see if the nipple turns inward.

• Do the same with your arms raised above your head.

  Your goal is get used to the feel of your breasts. This will help you to find anything new or different. If you do, call your provider right away.

Next, stand in front of a mirror with your arms by your side.

• Look at your breasts directly and in the mirror. Look for changes in skin texture, such as dimpling, puckering, indentations, or skin that looks like an orange peel.
• Also note the shape and outline of each breast.
• Check to see if the nipple turns inward.

Do the same with your arms raised above your head.

Your goal is get used to the feel of your breasts. This will help you to find anything new or different. If you do, call your provider right away.

Thyroid Diseases

Your thyroid is a butterfly-shaped gland in your neck, just above your collarbone. It is one of your endocrine glands, which make hormones. Thyroid hormones control the rate of many activities in your body. These include how fast you burn calories and how fast your heart beats. All of these activities are your body's metabolism.

Thyroid problems include

• Goiter - enlargement of the thyroid gland
• Hyperthyroidism - when your thyroid gland makes more thyroid hormones than your body needs
• Hypothyroidism - when your thyroid gland does not make enough thyroid hormones
• Thyroid cancer
• Thyroid nodules - lumps in the thyroid gland
• Thyroiditis - swelling of the thyroid

Skin Biopsy

Procedure Overview

A skin biopsy, where a physician removes a small sample of skin for testing, is a rapid and convenient office procedure that aids in the diagnosis of a patient's skin condition or lesion. Although usually done by a dermatologist, any physician who is skilled and knowledgeable with the technique and its indications can safely perform a skin biopsy. There are several techniques that involve sampling tissue from a skin lesion or eruption. Once removed, the tissue sample is processed and examined under a microscope by a pathologist. It usually takes several days before a final diagnosis is rendered.

Skin biopsy procedure selection very much depends on the suspected diagnosis, size, and location of the lesion.

Expected Results

A skin biopsy is often necessary when a skin condition cannot be diagnosed by the patient's history and what the physician finds on examination alone. Confirming a clinical diagnosis may also be necessary prior to starting therapy.

Skin biopsy types are as follows:

• Shave biopsies
• Punch biopsies
• Excisional biopsies

Skin biopsies can also be submitted for tissue culture if the diagnosis of a bacterial or fungal infection is in question.

Any skin lesion can be biopsied. It is important for patients to realize, however, that in some cases, microscopic examination of tissue may be very nonspecific and not necessarily helpful in rendering a specific diagnosis.

Preparation / Typical Procedure

The doctor performing the biopsy may ask in advance about any allergic reactions to anesthetic medications, about any blood thinner or anticoagulant medications you may be taking, or problems with bleeding in the past. Typically, there are no symptoms or conditions in a patient that would cause a physician to not perform a skin biopsy, but these questions help the doctor anticipate and better manage any potential complications (eg, excess bleeding). Otherwise, there is no special preparation needed prior to the procedure.

Once the area of interest is cleansed with alcohol or antiseptic solution, local anesthetic is injected in and around the skin lesion of interest using a syringe topped with a very fine needle. The skin biopsy is performed by the doctor using one of the methods described below, and the tissue removed is then placed in a bottle. Three commonly performed skin biopsy procedures are as follows:

• Shave biopsy – This is a superficial skin biopsy performed by a doctor where a thin layer is shaved off the surface of a lesion.
• Punch biopsy – A doctor removes a cylindrical sample to view layers of a lesion.
• Excisional biopsy – The doctor uses a scalpel to remove the entire visible portion of a lesion.

Following the Procedure / Aftercare

Antibacterial ointment or Vaseline® with a small dressing or Band-Aid® is placed over the wound.

The patient is advised to keep the wound dry for the next 24 hours; thereafter, it may be gently cleaned with soap and water. Applying antibacterial ointment or Vaseline may be done on a daily basis until the wound heals.

Risks or Side Effects

• Bleeding
• Pain
• Infection
• Non-healing wound (this is a greater risk if the biopsy is done on the lower legs)
• Scaring
• Keloid formation

Additionally, biopsies cannot diagnose all skin conditions. As such, a biopsy of a lesion may not necessarily reveal the correct diagnosis.

Alternatives

A skin biopsy may not be necessary before definitive treatment is offered to a patient. The physician may be able to make a judgement on a diagnosis and proper treatment based on other tests or a physical exam. For example, a physician may be able to do what is known as a skin scraping and view the skin cells under a microscope, or a skin culture can be helpful in diagnosing infection.