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Skin biopsies are essential procedures for health care providers who manage skin conditions. These office-based procedures can be used for the diagnosis of suspicious dermatologic lesions or definitive treatment for some malignant, irritated, or precancerous lesions.
This video will walk you through best practices for performing cutaneous biopsies.
Biopsy Supplies and Set-up
Proper exam room setup is essential for reducing prep time and improving efficiency when performing biopsies.
This educational video teaches the recommended tools needed for each type of biopsy.
Punch biopsies yield full-thickness samples and can be used for diagnosing lesions that require dermal and subcutaneous tissue. They are ideal for tumors that are too deep to be sampled by shave technique and for inflammatory conditions that have a deep component. Punch biopsies smaller than 3mm should be avoided.
Superficial Shave Biopsy
The shave biopsy technique is commonly used because of how quickly it can be performed, the simplicity of wound care, cosmesis, and cost-effectiveness.
A superficial shave biopsy removes a thin disk of tissue typically by scalpel (generally a #15 blade), although most physicians prefer a double-edged razor blade. The procedure yields a flat, thin specimen of combination epidermis and upper dermis.
As such, it is the most effective method of sampling raised lesions such as warts, papillomas, skin tags, pyogenic granulomas, non-melanoma skin cancers, and a variety of keratoses.
In a saucerization biopsy, a thick disk of tissue is removed with a curved blade yielding a specimen that extends to at least the mid-dermis.
It is useful for sampling or removing larger lesions.
Although most lower extremity foot and leg ulcers may be venous, arterial, or neuropathic, patients presenting with a lower extremity nonhealing wound of long duration, which may not be responding to treatment (2 months or longer), should be considered for a wound biopsy (punch or curettage) procedure to determine the presence or absence of malignancy or inflammatory condition.
Ideally, two biopsies should be performed to include both the base of the ulcer (for malignancy) and the wound margin (for inflammatory causes).
Fine Needle Aspiration Biopsy
A fine needle aspiration biopsy provides a sample of fluid and/or cells from a deep-seated subcutaneous mass for diagnosis.
Avoid removing a soft tissue mass before determining a definitive diagnosis based on the fine needle aspiration biopsy, such as lipoma, ganglion cyst, sarcoma, soft tissue tumors, or lesions that may resemble epidermal inclusion cysts.