Skin Biopsy (Skin Lesion Biopsy, Shave Biopsy, Punch Biopsy, Excision Biopsy)

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Definition

Removal of a small portion of abnormal skin to be tested in a laboratory. There are four main types of skin biopsies:

  • Shave biopsyThe outer part of the suspect area is removed.
  • Punch biopsyA small cylinder of skin is removed using a punch tool.
  • Wedge biopsySimilar to a punch biopsy but somewhat deeper, this biopsy is often performed with a scalpel in order to diagnose disorder of deeper layers of the skin.
  • Excision biopsyThe entire area of abnormal growth is removed.

Punch Biopsy

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Parts of the Body Involved

Skin

Reasons for Procedure

A skin biopsy is done to evaluate and/or remove a skin growth. It is most often done for the following reasons:

  • To diagnose bacterial or fungal infection, cancer , inflammatory skin disorders (such as psoriasis ), or benign skin growths
  • To verify the presence of normal skin at the edge of an area from which a tumor was removed
  • To monitor the effectiveness of a treatment
  • To remove warts , moles , skin cancers , or other growths

Risk Factors for Complications During the Procedure

  • Previous treatment of inflammatory skin diseases and scar tissue from a previous biopsy can make diagnosis more difficult
  • Immunosuppression, bleeding disorders, or circulatory problems (such as diabetes ), which can lead to healing problems
  • Heart valve conditions, which increase the risk for inflammation of the heart's inner lining after surgeryIn this case, your doctor may want to place you on an antibiotic before and during your procedure (typically only for excisional biopsy).

What to Expect

Prior to Procedure

No significant preparation is required for this procedure.

During ProcedureCleaning of biopsy area, anesthesia AnesthesiaLocal Description of the ProcedureShave biopsyWith a sharp scalpel or razor blade, the doctor removes a thin slice of the outer area of the abnormal skin tissue.Punch biopsyThe skin around the abnormal area is pulled taught. A hollow punch instrument is pushed into the center or leading edge of the lesion in the skin, rotated to remove a sample of skin, and then removed. This type of biopsy provides a sample containing cells from all of the layers of the skin.Wedge biopsyTypically a scalpel blade is used to remove a deep wedge of skin. This type of biopsy provides a sample containing cells from the deepest layers of the skin. The resulting wound is closed with stitches.Excision biopsyThis type of biopsy is larger and deeper than the other three. The entire skin lesion is removed, as well as some extra normal tissue around the outside of the lesion.Depending on the amount of skin removed, the area may be closed with stitches and/or a sterile dressing. Facial stitches will be removed in 3-7 days; stitches on the trunk, arms, and legs are removed in 7-14 days. After ProcedureStitches and bandages are applied as needed. How Long Will It Take?5-20 minutes Will It Hurt?There may be some temporary pain and discomfort during this procedure, typically from the injection of the anesthetic, but this will subside when the procedure is completed.
Possible ComplicationsInfectionPeople who scar easily may form keloids (raised scar tissue) or wide spread scarsNerve damage (only in a few danger areas primarily on the face such as the temple or jaw) Average Hospital StayNone Postoperative CareKeep biopsy area clean and dry, and covered with a sterile bandage or gauze dressing or a band-aid for one to two days.Take pain medication if necessary. Outcome The removed skin tissue is analyzed at a laboratory and the results are given to your doctor within a few days. In the lab, the biopsy will be defined as either normal or abnormal. Abnormal results may indicate any of the following: Presence of bacteria or fungiInflammation of the skinBenign (noncancerous) skin conditionSkin cancerDepending on the results, your doctor will make recommendations for further treatment. Call Your Doctor If Any of the Following OccursSigns of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision site RESOURCES: American Society for Dermatologic Surgeryhttp://www.asds-net.org National Cancer Institutehttp://www.cancer.gov/ CANADIAN RESOURCES: BC Cancer Agencyhttp://www.bccancer.bc.ca/default.htm Canadian Dermatology Association
http://www.dermatology.ca/english/ Cancer Care Ontariohttp://www.cancercare.on.ca/ References: American Academy of Dermatology website. Available at: http://www.aad.org/default.htm . Habif T. Clinical Dermatology . 4th ed. St. Louis, MO: Mosby; 2004. The Yale University School of Medicine Patient's Guide to Medical Tests . Houghton Mifflin Company; 1997. Last reviewed October 2007 by Ross Zeltser, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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