Skin biopsy techniques
- Patrick C Alguire, MD, FACP
Patrick C Alguire, MD, FACP
- Senior Vice President for Medical Education
- American College of Physicians
- Barbara M Mathes, MD, FACP, FAAD
Barbara M Mathes, MD, FACP, FAAD
- Clinical Associate, Dermatology
- University of Pennsylvania
- Secretary Treasurer
- American Academy of Dermatology
- Section Editors
- Russell S Berman, MD
Russell S Berman, MD
- Section Editor — Skin and Soft Tissue Surgery
- Chief of Surgical Oncology
- New York University Langone Medical Center
- Stanley J Miller, MD
Stanley J Miller, MD
- Section Editor — Dermatologic Surgery
- Associate Professor of Dermatology and Otolaryngology/Head and Neck Surgery, Part-Time
- Johns Hopkins Hospital
The skin biopsy is a relatively simple but essential procedure in the management of skin disorders . The most commonly performed biopsy procedures are reviewed here.
More errors are made from failing to biopsy promptly than from performing unnecessary biopsies. Nevertheless, many dermatoses have nonspecific histopathology, and biopsy cannot substitute for good clinical skills [2-4]. Biopsy is indicated in the following circumstances (table 1) [2,4,5]:
●All suspected neoplastic lesions
●All bullous disorders
●To clarify a diagnosis when a limited number of entities are under consideration
- Alguire PC, Mathes BM. Skin biopsy techniques for the internist. J Gen Intern Med 1998; 13:46.
- Fitzpatrick TB, Bernhard JD. The structure of skin lesions and fundamental of diagnosis. In: Dermatology in General Medicine, 3rd ed, Fitzpatrick TB, Eisen AZ, Wolff K, et al (Eds), McGraw-Hill, New York 1987. p.47.
- Pariser RJ. Skin biopsy: Lesion selection and optimal technique. Mod Med 1989; 57:82.
- Pinkus H. Skin biopsy: a field of interaction between clinician and pathologist. Cutis 1977; 20:609.
- Arca MJ, Biermann JS, Johnson TM, Chang AE. Biopsy techniques for skin, soft-tissue, and bone neoplasms. Surg Oncol Clin N Am 1995; 4:157.
- Bart RS, Kopf AW. Techniques of biopsy of cutaneous neoplasms. J Dermatol Surg Oncol 1979; 5:979.
- Peters MS, Winkelman RK. The biopsy. Dermatol Clin 1984; 2:209.
- Krull EA, Babel DE. Diagnostic procedures of the skin. Part two: Skin biopsy and other tests. J Fam Pract 1976; 3:427.
- Olbricht S. Biopsy techniques and basic excisions. In: Dermatology, 1st ed, Bolognia JL, Rapini RP (Eds), Mosby, London 2003. p.2269.
- Harrison PV. A guide to skin biopsies and excisions. Clin Exp Dermatol 1980; 5:235.
- Hansen TJ, Lolis M, Goldberg DJ, MacFarlane DF. Patient safety in dermatologic surgery: Part I. Safety related to surgical procedures. J Am Acad Dermatol 2015; 73:1.
- Alam M, Lee A, Ibrahimi OA, et al. A multistep approach to improving biopsy site identification in dermatology: physician, staff, and patient roles based on a Delphi consensus. JAMA Dermatol 2014; 150:550.
- Dinehart SM, Hanke CW, Geronemus RG. Dermatologic Surgery for Medical Students, Association of Academic Dermatologic Surgeons, Schaumburg 1993.
- Snell G. Skin biopsy. In: Procedures for Primary Care Physicians, Pfenninger JL, Fowler GC (Eds), Mosby-Year Book, St. Louis 1994. p.20.
- Ritchie JM, Greene NM. Local anesthetics. In: The Pharmacological Basis of Therapeutics, 8th ed, Gilman AG, Rall TW, Nics AS, Taylor P (Eds), Pergamon Press, New York 1990. p.311.
- Firoz B, Davis N, Goldberg LH. Local anesthesia using buffered 0.5% lidocaine with 1:200,000 epinephrine for tumors of the digits treated with Mohs micrographic surgery. J Am Acad Dermatol 2009; 61:639.
- Krunic AL, Wang LC, Soltani K, et al. Digital anesthesia with epinephrine: an old myth revisited. J Am Acad Dermatol 2004; 51:755.
- Häfner HM, Röcken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges 2005; 3:195.
- Chowdhry S, Seidenstricker L, Cooney DS, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg 2010; 126:2031.
- Epperson WJ. Laceration and incision repair. In: Procedures for Primary Care Physicians, Pfenninger JL, Fowler GC (Eds), Mosby-Year Book, St. Louis 1994. p.7.
- Grekin RC. Simple dermatological surgical procedures. Res Staff Phys 1989; 35:61.
- Ng JC, Swain S, Dowling JP, et al. The impact of partial biopsy on histopathologic diagnosis of cutaneous melanoma: experience of an Australian tertiary referral service. Arch Dermatol 2010; 146:234.
- Todd P, Garioch JJ, Humphreys S, et al. Evaluation of the 2-mm punch biopsy in dermatological diagnosis. Clin Exp Dermatol 1996; 21:11.
- Howe N, Cherpelis B. Obtaining rapid and effective hemostasis: Part I. Update and review of topical hemostatic agents. J Am Acad Dermatol 2013; 69:659.e1.
- Stengel FM. Indications and technique of biopsy for diseases of the scalp. J Dermatol Surg Oncol 1978; 4:170.
- Christenson LJ, Phillips PK, Weaver AL, Otley CC. Primary closure vs second-intention treatment of skin punch biopsy sites: a randomized trial. Arch Dermatol 2005; 141:1093.
- Gambichler T, Senger E, Rapp S, et al. Deep shave excision of macular melanocytic nevi with the razor blade biopsy technique. Dermatol Surg 2000; 26:662.
- Karimipour DJ, Schwartz JL, Wang TS, et al. Microstaging accuracy after subtotal incisional biopsy of cutaneous melanoma. J Am Acad Dermatol 2005; 52:798.
- Comfere NI, Sokumbi O, Montori VM, et al. Provider-to-provider communication in dermatology and implications of missing clinical information in skin biopsy requisition forms: a systematic review. Int J Dermatol 2014; 53:549.
- Moy RL, Waldman B, Hein DW. A review of sutures and suturing techniques. J Dermatol Surg Oncol 1992; 18:785.
- Telfer NR, Moy RL. Wound care after office procedures. J Dermatol Surg Oncol 1993; 19:722.
- Sheth VM, Weitzul S. Postoperative topical antimicrobial use. Dermatitis 2008; 19:181.
- Smack DP, Harrington AC, Dunn C, et al. Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. A randomized controlled trial. JAMA 1996; 276:972.
- Noe JM, Keller M. Can stitches get wet? Plast Reconstr Surg 1988; 81:82.
- Bennett RG. Microbiological considerations in cutaneous surgery. In: Fundamentals of Cutaneous Surgery, Bennett RG (Ed), CV Mosby Company, St. Louis 1988. p.136.
- Gette MT, Marks JG Jr, Maloney ME. Frequency of postoperative allergic contact dermatitis to topical antibiotics. Arch Dermatol 1992; 128:365.
- Grolnik M. Factors involved in the production of adhesive plaster irritation. Am J Surg 1940; 50:63.
- SITE SELECTION
- BIOPSY TECHNIQUES
- General measures
- Biopsy site identification
- Preparing the site
- Choice of procedure
- Shave biopsy
- - Hemostasis
- Punch biopsy
- Pigmented lesions
- Processing the biopsy sample
- Pathology requisition information
- - Choice of suture and needle
- - Closing
- Wound dressing
- Suture removal
- Sample patient instructions for wound care
- - Open wounds
- - Sutured wounds
- Sample procedure notes
- - Shave biopsy
- - Punch biopsy
- - Elliptical excision
- SUMMARY AND RECOMMENDATIONS