A skin biopsy is a procedure in which a doctor cuts and removes a small sample of your skin to have it tested. This sample may help your doctor diagnose diseases such as skin cancer, infection, or other skin disorders.
TYPES OF SKIN BIOPSY
The several types of skin biopsy that can be carried out on the skin:
- Excisional Skin Biopsy: The doctor uses a scalpel (small knife) to take off the entire lesion (lump or an area of abnormal skin) including a portion of normal skin down to or through the fatty layer of skin. This method is used for smaller lesions. You’ll likely receive stitches to close the biopsy site after this procedure.
- Incisional Skin biopsy: The doctor uses a scalpel to remove a small sample of a large lesion ( lump or an entire area of abnormal skin).
- Shave biopsy: Here, the doctor shaves a thin layer from the top or around a lesion. A tool similar to a razor (double edged) is used to cut out a small section of the top layers of skin (epidermis and a portion of the dermis). A shave biopsy causes bleeding. The Bleeding is stopped by applying pressure to the area or by a combination of pressure and a topical medication applied to the biopsy site.
- Saucerization: is performed if the dermatologist envisions that the disease or tumor extends into the upper or mid dermis. In this type of biopsy, the edge of the blade is at a greater angle relative to the surface of the skin. This type of biopsy is often done on the trunk.
- Punch biopsy: The doctor uses an instrument called a punch (circular tool) to remove a small circular section of skin including deeper layers (epidermis, dermis and superficial fat). Stitches may be needed to close the wound. A dressing or adhesive bandage is then placed over the site to protect the wound and prevent bleeding.
PREPARATION FOR SKIN BIOPSY
Before the skin biopsy, you should tell your doctor if you have any known medical history of the following:
- Have been diagnosed with a bleeding disorder
- Have a history of skin infections, including impetigo
- Are taking blood-thinning medications, such as aspirin, aspiring-containing medications, warfarin (Coumadin) or heparin
- Are taking medications that suppress the immune system, such as diabetes medications or medications used after an organ transplant
- Have experienced excessive bleeding after other medical procedures
PROCEDURE FOR SKIN BIOPSY
- The doctor will first cleanse the biopsy site,
- The doctor numbs the skin by using an anesthetic (pain-relieving) injection.
- The skin is then sampled using one of the above procedures.
NOTE: Shave biopsies do not usually need stitches, while punch, excisional, and incisional biopsies will usually be closed with sutures or steri-strips. The procedure is usually done in the doctor’s office.
EXPECTATION BEFORE SKIN BIOPSY
Depending on the location of the skin biopsy, you may be asked to undress and change into a clean gown. A doctor or nurse then cleans the area of the skin to be biopsied. Your skin may be marked with a surgical marker or marking pen to outline the biopsy area.
You then receive a local anesthetic to numb the biopsy site. This is usually given by injection with a thin needle. The numbing medication can cause a burning sensation in the skin for a few seconds. Afterward, the biopsy site is numb and you shouldn’t feel any pain or discomfort during the skin biopsy.
EXPECTATIONS AFTER SKIN BIOPSY
What a patient should expect after undergoing skin biopsy in no particular order are as follows:
SORENESS – After the skin biopsy is done you may have some soreness on or near the biopsied site for a few days.
DISCOMFORT– Tylenol is usually sufficient to relieve any discomfort. If you had stitches after the procedure, keep the area clean and moist. Your doctor will tell you when the stitches should be removed within one week.
SCAR – You should expect a small scar from the biopsy….unavoidably due to the fact that incisions are made. All biopsies cause a small scar. Some people develop scars that are either prominent, or raised. The risk of scarring is increased when a biopsy is done on the neck or upper torso (the back or chest).
BLEEDING: Occasionally, the biopsy site bleeds after you leave the doctor’s office. This is more likely to occur in people taking blood-thinning medications. If this occurs, apply direct pressure to the wound for 10 to 20 minutes. If bleeding continues, see your doctor immediately.
HEALING: Healing of the wound can take several weeks, but is usually complete within two months. Wounds on legs and feet tend to heal slower than those on other areas of the body.
- If adhesive steri-strips (which look like small pieces of tape) were used to close the incision, keep the area dry and do not remove them. They will gradually fall off on their own. If the strips do not fall off on their own, your doctor will remove them at your follow-up appointment.
- Try not to bump the biopsy site area or do activities that might stretch the skin. Stretching the skin could cause the wound to bleed or enlarge the scar.
- Initially, the scar will be pink and then fade gradually to white or sometimes brown. The permanent color of the scar becomes evident one or two years after the biopsy.
TOTAL TIME TAKEN TO CARRY OUT SKIN BIOPSY
The procedure is non-time consuming. It typically takes about 15 minutes total, including the preparation time, dressing the wound and instructions for at-home care.
WHAT HAPPENS TO THE SKIN SAMPLE COLLECTED?
When biopsy has been successfully carried out, your doctor sends the sample to the laboratory for testing. The tissue is processed, and a pathologist examines the skin biopsy sample under a microscope to determine if there is any disease. The results usually come back within one to two weeks.
Depending on the skin condition, type of biopsy and the laboratory procedures, results may take several days or a couple of weeks. Results of biopsies for metabolic or genetic testing can take several months or more.
Your doctor may schedule an office appointment to discuss the results of the test. If possible, bring along a family member or friend. It can be difficult to absorb all the information provided during an appointment. The person who accompanies you may remember something that you forgot or missed.
BASIC QUESTIONS TO ASK YOUR DOCTOR
Patients should learn to exhibit a certain level of curiosity with happenings around them. Don’t be afraid to ask questions or to speak up when you don’t understand something. During biopsy, some basic questions you should ask your doctor are as follows-
- Based on the results, what are my next steps?
- Will I need to repeat the test at some point?
- What kind of follow-up, if any, should I expect?
- Are there any factors that might have affected the results of this test and, therefore, may have altered the results?
- If the skin biopsy showed skin cancer, will I need additional treatment?
COMPLICATIONS AND WHEN TO CALL THE DOCTOR
As a patient who has just undergone skin biopsy, you should call your doctor or health care provider when you experience complications such as
- Bleeding – that cannot be stopped by normal pressure application
- Signs of infection – redness, pus, warmth, tenderness.
Note: you can also reach out to your doctor if you have questions or concerns bothering you after skin biopsy.
SKIN CONDITIONS THAT REQUIRE SKIN BIOPSY DIAGNOSIS
A skin biopsy may be necessary to diagnose or to help treat skin conditions and diseases such as –
- Skin infection
- Skin tags
- Actinic keratosis
- Bullous pemphigoid
- Blistering skin disorders
- Dermatitis, psoriasis and other inflammatory skin conditions
- Suspicious Growth on the skin
- Skin cancers, including basal cell carcinoma, squamous cell carcinoma and melanoma
RISK ASSOCIATED WITH SKIN BIOPSY
Although skin biopsy is a completely safe procedure, complications cannot totally be ruled out. Below are some possible risk–
- Allergic reaction to topical antibiotics
HOW TO CARE FOR A SKIN BIOPSY SITE DURING HEALING
- Cover the site with an adhesive bandage that allows the skin to ventilate.
- Wash your hands with soap and water before touching the biopsy site.
- Continue caring for the biopsy site until the stitches are removed
- For shave biopsies that don’t require stitches, continue wound care until the skin is healed.
- After rinsing, ensure to Pat the site dry with a clean towel.
- If the biopsy site is on your scalp, wash with shampoo.
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