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What You Should Know About Punch and Shave Biopsies

August 28, 2018

If you have a skin lesion or growth, it’s very likely that your dermatologist will want to do a biopsy to best diagnose whether it is something to be concerned about. For conditions like keratosisdysplastic nevi or skin cancer, biopsies are quick office procedures that can be instrumental in providing necessary information about a growth and informing how your doctor proceeds.

“A biopsy is a relatively simple procedure that can be done quickly and easily in your dermatologist’s office,” says Dr. Howard Rubin, a board-certified dermatologist at Rubin and Reddick Dermatology in Dallas, Texas. “Since it’s an outpatient procedure, you can arrange to have it done in just a few minutes with no downtime, and there’s no need for hospitalization.”

What You Need to Know About Shave Biopsies

A shave biopsy is exactly what it sounds like. Using a scalpel, blade, double-edged razor or scissors, your doctor will remove a thin layer of tissue from the growth or lesion. This gives them a specimen to examine and determine what the next steps should be.

The shave biopsy is the most widely used biopsy technique because it is easy and quick to perform. It is very simple for the patient to care for afterward, the procedure has very little discomfort and does not cost much to perform. It also has a very low risk of scarring because it doesn’t require stitches or sutures. (However, the skin where the biopsy was performed may be pink for a few months, and afterward could either be hypopigmented or hyperpigmented.)

A shave biopsy can be used in a variety of instances but is generally used more for superficial conditions. This can include warts, papillomas, skin tags, superficial basal or squamous cell carcinomas and seborrheic or actinic keratosis. Most recently, it has become an acceptable method for diagnosing melanoma.

What You Need to Know About Punch Biopsies

A punch biopsy is performed using a medical instrument with a circular blade, called a punch, to remove a circular sample of the lesion. It can penetrate deeper into the skin, depending on the area being biopsied, to include the epidermis, dermis and subcutaneous fat.

Punch biopsies are used for diagnosing skin malignancies like basal cell carcinoma and squamous cell carcinoma, as well as identifying benign growths, inflammatory lesions and chronic skin disorders.

While stitches or sutures are not required for a shave biopsy, the area where a punch biopsy is performed will often need to be closed with sutures or with sterile adhesive strips. Any time the skin has been cut, of course, there is a risk of a scar, and the bigger the incision, the greater the likelihood. If this is something that you’re concerned about, you should discuss it with your dermatologist before receiving a punch biopsy.

What to Expect During a Biopsy Procedure

When you are having a biopsy performed, your doctor will use a local anesthetic to numb the tissue-sample area. Because of this, there is usually little to no pain involved in the procedure. You may feel some pressure but not actual pain or discomfort.

To perform the biopsy, your doctor will stretch the skin around the lesion to create a taut, flat area, then remove the tissue sample with the appropriate instrument. If the procedure requires closure, it will be done immediately, and you’ll likely be given an antibiotic ointment to apply to the area to keep it from becoming infected. You will cover the area with gauze or a bandage to keep it protected as it heals.

After the Biopsy

In the days following the biopsy, depending on the size of the tissue sample and the method used, you may experience a little bit of tenderness or soreness in the area where the procedure was performed. This is generally very mild and can typically be managed with a pain reliever like Tylenol.

If your biopsy required stitches, your doctor will set an appointment for you to return and have them taken out; if the incision was closed with sterile adhesive strips, it is fine to let them fall off on their own.

While complications from biopsies are unusual, you should let your practitioner know if you have bleeding from the biopsy site that you’re not able to stop. Also let your doctor know if you have signs of an infection in the site, such as pus, red streaks or warmth and redness to the skin in the surrounding area.

What Happens Next?

After taking the tissue sample during your biopsy, your practitioner will send it to a lab for processing and examination by a pathologist. You normally will be informed within one to two weeks what the biopsy revealed and can decide with your dermatologist what the next steps should be.

“The type of biopsy that your dermatologist recommends is going to be based on several personal factors, such as where it’s located, the depth of tissue sample required, the possible cosmetic outcomes and the suspected type of lesion,” Dr. Rubin says. “Being able to talk with your dermatologist about any concerns is important in making you feel more comfortable about the procedure.”

When you have a skin lesion or growth that is causing concern, a biopsy is likely the fastest and safest way to determine whether it is benign or malignant and whether it needs further medical attention. Either way, a biopsy will give you peace of mind and can remove the lesion with minimal or perhaps even no scarring at all.

Don’t let a small skin concern grow into something larger. If you notice a growth or lesion on your skin, make an appointment with your board-certified dermatologist to discuss your concerns and explore your options.

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