Skin Biopsy

Definition:
A biopsy of a lesion of the skin, such as in mole removal or tumor removal, can help your doctor tell the difference between a skin cancer and a benign, or noncancerous, lesion. The skin sample obtained during a biopsy is sent to a laboratory for examination under a microscope.

For this test, abnormal areas of skin are removed to test for cancer or other skin diseases.

Doctors take biopsies of areas that look abnormal and use them to detect cancer, precancerous cells, infections, and other conditions. For some biopsies, the doctor inserts a needle into the skin and draws out a sample; in other cases, tissue is removed during a surgical procedure.

Your doctor may want to obtain a sample of skin in order to diagnose diseases of the skin, such as those caused by bacteria, fungi, or other chronic skin conditions. This procedure is called a skin biopsy.

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How the procedure is performed?
*In an excision biopsy, the entire area of suspect skin is cut out. Excision biopsy is normally done with a scalpel. Stitches are used to close the incision.

*In a punch biopsy, a sharp cookie cutter -like instrument is used to remove a small cylinder of skin. Sometimes stitches are necessary to close this type of biopsy wound.

*The outermost part of a lesion can also be shaved off with a scalpel. This is called a shave biopsy.

If you have a lesion on your skin that is fluid-filled and not solid, this can be evaluated with aspiration. Your doctor can put a small needle attached to a syringe into this lesion and suction out the fluid.

How do you prepare for the test?

*Skin biopsy is routinely done in the doctor’s office. You may be asked to change into a gown or remove an article of clothing so that the area of suspect skin can be more easily seen and removed.

*Tell your doctor if you have any allergies to medications, and especially if you have had any reactions to local anesthetics, such as lidocaine or Novocain, or to iodine cleaning solutions, such as Betadine.

*Inform your doctor if you are taking any medications, including over-the-counter drugs, street drugs, or herbal or nutritional supplements.

*Tell your doctor if you have any bleeding problems or if you are pregnant.

What risks are there from the test?
You should discuss with your doctor the following potential risks and complications of the biopsy procedure. You will need to sign a consent form before the procedure.

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Possible risks include these:
*Bleeding from the biopsy site
*Pain
*Local reaction to the anesthetic
*If you had an excisional biopsy, you’ll have a scar shaped like a straight line.(Scars are rare following a punch biopsy.)
*Following any kind of incision into the skin, some people develop keloids-reddish lumps on the healing skin.
*Infection

Healing problems – If you tend to form large scars (keloids), you have an increased chance of forming a scar over the biopsy site. Smoking and some chronic medical conditions such as diabetes affect the healing ability of the skin.
What happens when the test is performed?
This procedure is done in a doctor’s office, often by a dermatologist. The doctor begins by injecting a local anesthetic near the biopsy site. Although the injection usually stings for a second, the rest of the procedure is painless. Depending on the size of the lesion, one of two methods will be used to remove or sample it.

For small lesions and tissue samples, your doctor might do a punch biopsy, in which he or she places an instrument shaped like a straw with a sharp end against your skin and twists it. The sharp end works like a cookie cutter to slice a small circle from the top layer of skin. The doctor lifts the tissue away with tweezers. A single stitch closes the opening in the skin.

Larger lesions and tissue samples are removed with an excisional biopsy. In this case, the doctor uses a blade to cut an oval opening around the area. The doctor will stop any bleeding with a cauterizer, a wand-shaped instrument that uses an electric current to seal the ends of bleeding blood vessels. You’ll also need stitches to close the incision.
The tissue that is removed is sent to the laboratory for analysis by a pathologist.

With both types of biopsies, the skin sample is then given to a pathologist and examined under a high-powered microscope.You’ll probably be able to go home right afterward.

For skin biopsies that are being tested for melanoma, the most serious form of skin cancer, your doctor will try to remove the entire area that looks abnormal. That way, the biopsy will not only determine if the lesion is malignant, it might also cure the cancer. The sample will be examined under a microscope to make sure the whole cancer has been removed. You might need additional skin surgery if the examination shows that the cancer extended to the margins of the skin sample.

After the Procedure:
*To Keep the healing wound clean and dry.Your doctor will put a bandage over your biopsy site. Keep this bandage dry. You may be advised to wash the wound, apply antibacterial ointment, and change the bandage daily.

*If you have stitches, you need to keep the area clean and dry. Follow instructions regarding when and how to wash the wound.
Stitches on the face are removed in 5-8 days. Stitches placed elsewhere on the body are removed in 10-14 days. Adhesive strips are left in place for 10-21 days.

*If you have pain at the biopsy site, talk with your doctor about medication to relieve it. In most cases, discomfort is minimal and requires nothing more than an over-the-counter pain medication.

Next Steps:
Your doctor needs to see you again to remove the stitches and to give you the results of the pathology report.

When to Seek Medical Care:
Call your doctor if you have worsening pain, spreading redness around the site, bleeding from the wound, fever (temperature greater than 100.4°F), or other concerns.

Go to a hospital’s emergency department if you have bleeding from the site that will not stop with gentle pressure, if you have a thick discharge (pus) from the wound, or if you have a high fever.

How long is it before the result of the test is known?
It can take several days to get your results.

Resources:
https://www.health.harvard.edu/diagnostic-tests/skin-biopsy.htm
http://www.emedicinehealth.com/skin_biopsy/article_em.htm

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