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Skin Biopsies

What is a skin biopsy used for?

Skin biopsies are used to diagnose skin cancer, as well as unusual rashes or skin disease that does not respond to therapy.  Skin biopsies are typically done in office and are relatively painless and completed quickly.

Types of Skin Biopsies

There are two main types of skin biopsies:  shave biopsy and punch biopsy.

Shave Biopsy

This is the most common biopsy used in our office.  This allows us to control the depth and width of the biopsy.  We can remove an entire lesion or simply take a small sample of a spot of concern.  There are no sutures required.

Punch Biopsy

We utilize this biopsy more with skin rashes than with “spots of concern”.  This device has a circular blade that is rotated back and forth through the layers of the skin.  This allows us to sample all three layers of the skin from the top down to the fat layer.  These punch biopsy tools come in different widths such as 2 mm, 4 mm, 10 mm, etc.  Most of the time we utilize a 4 mm punch tool.

This type of biopsy typically requires a suture afterwards to close the skin.  When utilizing a 4 mm punch biopsy tool generally only one suture is required.  Occasionally, if we are using a 2 mm punch biopsy tool we may allow the skin to heal in by itself without any sutures.  Larger punch biopsy tools may require more than one suture.

What happens during the biopsy?

The very first thing that happens is the procedure is explained to you from start to finish and then consent forms are signed.  The entire procedure, although seems lengthy, takes about 5 minutes.

  1. The spot of concern is marked usually by drawing a circle around it with a surgical marking pen.
  2. Photos are taken of the spot of concern, so we know the exact location.
  3. The area is cleaned with rubbing alcohol.
  4. TIME OUT! This is where we stop for a moment and confirm patient name, DOB, procedure, etc.
  5. Inject lidocaine usually mixed with epinephrine into the spot to be biopsied.
  6. Take a small sample of the spot of concern or remove the entire lesion depending on our goals. We will either use a “Shave Biopsy” or “Punch Biopsy” during this step.  That will have been discussed with you prior to the procedure.
  7. If a punch biopsy was used in step #6, we will now put a suture in to close the skin. If a shave biopsy was used in step #6, we will stop the bleeding usually with Drysol.
  8. Finally, the biopsy site is cleaned and then Vaseline and a band-aid applied.
  9. We will call you with your biopsy results when they are available and let you know what the next steps are. If a suture was used, we will schedule an appointment to remove the suture.

What are possible complications with a biopsy?

Typically, there are three main items to worry about with a biopsy and keep in mind that this is a very low risk procedure.

  1. Bleeding: Blood loss is nonexistent or very small during a shave or punch biopsy.  We will stop any bleeding prior to you leaving the office.  This may include using Drysol, Pressure Bandage, Electrocautery, or Silver Nitrate.
  2. Scarring: There will be some type of scar post-procedure.  This is usually very minimal, and we can recommend different treatments post-procedure to help minimize the scar.
  3. Infection: This is rare from a biopsy.  Post-care is typically band-aids and Vaseline.  Signs of infection like yellow to green drainage, expanding redness, and bad odor could be signs of infection.  If that is the case, we may prescribe a topical antibiotic or even one by mouth.
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