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

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

Definition

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

Shave biopsy—The outer part of the suspect area is removed.
Punch biopsy—A small cylinder of skin is removed using a punch tool.
Wedge biopsy—Similar 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 biopsy—The entire area of abnormal growth is removed.

Punch Biopsy

Nucleus factsheet image

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 [1] , inflammatory skin disorders (such as psoriasis [2] ), 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 [3] , moles [4] , skin cancers [1] , 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 [5] ), which can lead to healing problems
Heart valve conditions, which increase the risk for inflammation of the heart's inner lining after surgery—In 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 Procedure

Cleaning of biopsy area, anesthesia

Anesthesia

Local

Description of the Procedure

Shave biopsy—With a sharp scalpel or razor blade, the doctor removes a thin slice of the outer area of the abnormal skin tissue.
Punch biopsy—The 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 biopsy—Typically 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 biopsy—This 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 Procedure

Stitches and bandages are applied as needed.

How Long Will It Take?

5-20 minutes

Will It Hurt?

There may be some temporary pain [6] and discomfort during this procedure, typically from the injection of the anesthetic, but this will subside when the procedure is completed.

Possible Complications

Infection
People who scar easily may form keloids (raised scar tissue) or wide spread scars
Nerve damage (only in a few “danger areas” primarily on the face such as the temple or jaw)

Average Hospital Stay

None

Postoperative Care

Keep 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 [6] 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 fungi
Inflammation of the skin
Benign (noncancerous) skin condition
Skin cancer [7]

Depending on the results, your doctor will make recommendations for further treatment.

Call Your Doctor If Any of the Following Occurs

Signs of infection, including fever and chills
Redness, swelling, increasing pain [6], excessive bleeding, or discharge from the incision site

RESOURCES:

American Society for Dermatologic Surgery
http://www.asds-net.org [8]

National Cancer Institute
cancer [9].gov/">http://www.cancer [7].gov/

CANADIAN RESOURCES:

BC Cancer Agency
http://www.bccancer.bc.ca/default.htm [10]

Canadian Dermatology Association
http://www.dermatology.ca/english/ [11]

Cancer Care Ontario
http://www.cancercare.on.ca/ [12]

References:

American Academy of Dermatology website. Available at: http://www.aad.org/default.htm [13] .

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, MD [14]

Please 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 [15] 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 [16] provider prior to starting any new treatment or with any questions you may have regarding a medical [15] condition.