The unit has one room for major procedures, one room for some minor procedures, and one room for preparing the patients for surgery.The unit receives surgical consultations from all dermatology centers in Kuwait, AlBabtain center and other specialties.

 Working days schedule

Day	Procedures under L/A
Sunday	Electrosurgery, Cryosurgery resistant wart surgery acne scaring corrective surgery (subcision, excision, dermabrasion) chemical peeling for xanthelesma,  excision of benign tumors etc keloid injection
Monday	Hair clinic and  general skin biopsies
Tuesday	General skin biopsies and procedures
Wednesday	Mohs micrographic surgery for malignant tumors Excision of malignant tumors with postoperative flaps & grafts repairs Surgical treatment of keloids & adjuvant therapy Keloidectomy
Thursday	General skin biopsies

Unit receives urgent requests for skin biopsies from hospitals at Sabah area in-patients and OPD at As’ad Al Hamad center. The patients will be assessed as urgent matter by the pathologist and the dermatosurgeon.

Any patients who referred from other dermatologists from Kuwait for skin biopsy, should have the skin biopsy pathology request with the patient in order to be seen directly by the dermatosurgery unit and pathology staff, otherwise if the referring dermatologist wrote a regular consultation letter, that patient will be directed to the OPD at As’ad  Al Hamad to be assessed by the dermatologist first then fill the skin biopsy pathology request in order to be seen by the dermatosurgery and pathology unit

Any patient on Aspirin, Plavix can get skin biopsy without stopping it. Any patients on Warfarin, INR should be therapeutic before 48 hours  (INR 2-3). Major procedures like Mohs surgery, the surgeon will decide whether to hold anticoagulants or not before surgery. If platelets are under 20,000, then skin biopsy should be postponed until its more than that level, otherwise the hematologist should transfuse FFP and platelets. 

Diabetic patients  should check their blood sugar at the derm surgery unit,  with our glucometer, if they refused to do so or if the patient insisted to do the biopsy without checking or the dermatosurgeon wants to do the  procedure in spite of high blood sugar, the patient should be aware for any complication and sign a consent.

The referring Doctor at As’ad AlHamad has to open a file for each patient that belongs to our catchment area before doing a skin biopsy and filling the request form for dermatopathology.

The dermatosurgeon will open a file if the patient is referred from other specialist

Photography is obligatory for selected cases

Nurse will do assessment and give the patient a questionnaire to fill and measure vital signs

Patients booked for Mohs surgery will be handed information sheet and consent

Consent will be signed by the patient before any procedure.

 The group of dermatopathologist and the derm surgeon will assess the patient to get the clinico-pathological correlation

Surgical check list will be attached to file and MR10.

 The results of the biopsy will take 7-14 days, the patient will get the results from the dermatopathology unit.

Unit members meet every 6 months to improve work

The surgical check list protocol as follows:

Time out : Immediately before starting the procedure, Time out should be conducted in the OP/ procedure room before the incision. It should involve the entire operative team, use active communication, be briefly documented, such as in a check list

Should include:

1. The correct patient identity ( triple name and CID, and match them to the specimen bottle and request form)
2. Correct side and site ( match identity and site if multiple specimens)
3. Agreement on the procedure to be done (MR5)

How to do it:

Make the mark at or near the incision site. Do not mark any non operative site(s).

The mark should be unambiguous, Do Not use X on the site.

The mark should be positioned to be visible after the patient is prepped and draped.

The mark should be made using a marker that is sufficiently permanent to remain visible after completion of the skin prep. Adhesives site markers should not be used.

The method or marking should be consistent throughout the organization.

The marking should be made by an individual that is familiar with the patient and is involved with the patient’s procedure. This individual is encouraged to be the surgeon or individual permitted through the residency program to participate in the procedure.

Marking should take place with the patient involved, wake and aware, If possible.

Final verification of the site mark should take place during Time Out.     

Exception: Cases in which the individual doing the procedure is in continuous attendance with the patient from the time of the decision to do the procedure and consent from the patient through to the conduct of the procedure may be exempted from the site marking requirement. The requirement for TIME OUT final verification still applies.