Skin biopsy (excisional, incisional, punch, shave)
What is a skin biopsy, what types are there?
Skin biopsy is an intervention frequently used in dermatological practice in order to obtain a definite diagnosis. Clinical examination is not always enough, so the dermatologist uses skin biopsy to distinguish between similar conditions, by studying the structure of the skin under a microscope.
Depending on the type of skin lesion, its characteristics and the presumptive diagnosis, the specialist may opt for one of the following biopsy methods:
• Shave biopsy - involves removing the superficial layers of the skin with a scalpel blade. The defect does not require suturing. It is used in the case of seborrheic keratoses, actinic keratoses, etc.
• Punch biopsy - involves the use by the doctor of a special tool called a "punch" which is actually a metal cylinder with a sharp edge, which removes a piece of skin. Depending on the size of the defect (4-8 mm) it can be closed with 1-2 sutures. The depth of the biopsy reaches the subcutaneous tissue. It is used to evaluate pathological processes with deeper localization, being useful in the case of inflammatory dermatoses or those associated with deposits.
• Excision biopsy - removes the entire lesion. The result is an elliptical skin defect that closes with sutures. In the case of skin cancers, the excisional biopsy will be performed respecting the oncological safety limits, to ensure that all the affected tissue has been removed.
• Incisional biopsy - is used to remove a portion of the lesion, in the case of large area lesions. The result requires 1-2 threads. The depth of the incision reaches the subcutaneous tissue.
What is the procedure?
The procedure consists in taking a small fragment of skin tissue using the tools specific to each biopsy, which will then be examined under a microscope by a pathologist. The operation is performed under local anesthesia. The remaining skin defect is corrected by thread suturing or only hemostasis is done by electrocautery and healing is obtained per second. Where sutures have been used, they will be removed within 12-14 days after the biopsy. The biopsy tissue is sent to specialized laboratories for histopathological analysis. Biopsy results are available in 5 to 10 days.
What happens before the skin biopsy?
Before any surgical procedure it is important to tell your doctor if you suffer from any other conditions, if you are allergic to anesthetic or other medicines. It is important to tell your doctor in advance if you are being treated with anticoagulants (blood thinners; eg symptoms, thrombostop, etc.) or antiplatelet agents (eg aspirin, Plavix, etc.).
Before the procedure you can consume food and fluids, you are also encouraged to take your chronic medication (for high blood pressure, diabetes, etc.).
How long does a skin biopsy take?
The duration of the intervention is about 20-30 minutes.
How should the area be cared for after the procedure?
Post-intervention care consists of local grooming with disinfectant and application of an antibiotic ointment for 7-14 days to prevent superinfection. It is also necessary to avoid exposing the biopsied area to UV radiation and to use a cream with a high protection factor.
When is a skin biopsy needed?
It is required for:
obtaining a definite diagnosis establishing appropriate therapeutic conduct
monitoring the evolution of a dermatological condition
determining the type of tumor and the level of invasion
What are the benefits of a biopsy?
• is a safe, effective method for diagnosing inflammatory, autoimmune and tumor skin diseases
• is performed under local anesthesia and is therefore not painful
• patients can resume their usual activities soon
• provides clear and precise results
What are the side effects or complications?
• moderate pain that can be controlled with mild painkillers
• Mild bleeding
• defective scarring (hypertrophic / keloid / atrophic scars)
What are the contraindications to the procedure?
It is not recommended to perform this procedure if:
• have a known allergy to the anesthetic used
• you are pregnant or breastfeeding (relative contraindication related to local anesthesia, when assessing the risk / benefit ratio of the procedure and deciding the need for a biopsy)
• follow a systemic anticoagulant treatment (relative contraindication - there is a risk of postoperative bleeding)
Skin biopsy (base cauterization shave) / lesion