II. Indications: Full thickness skin specimen
- Diagnosis of Inflammatory skin diseases
- Diagnosis of neoplasms
- Systemic Lupus Erythematosus or Discoid Lupus
- Lichen Planus
- Drug Eruptions (Requires depth)
III. Determining optimal biopsy site
-
Macule
- Biopsy area most abnormal in color
- Advance punch into subcutaneous fat
-
Papule
- Excise completely if possible
- Biopsy larger Papules through thickest area
-
Plaque
- Biopsy through thickest area
- Advance punch into subcutaneous fat
-
Nodule or tumor
- Biopsy through thickest area
- Advance punch into subcutaneous fat
-
Vesicle
- Excise Vesicle intact to optimize histology
- Bulla
IV. Technique
- Mark area of lesion to biopsy with surgical marker
- Select most abnormal portion of lesion
- Determine Punch Biopsy size (2-6 mm)
- Administer Local Anesthetic
- Prepare and drape area for incision
- Stretch skin perpendicular to Skin Tension Lines
- Rotate skin punch into Dermis
- Remove punch when it enters subcutaneous fat
- Beware of superficial neurovascular structures
- Elevate specimen above incision
- Use sterile 21 gauge needle
- Avoid forceps due to crush injury of specimen
- Cut specimen free on undersurface with iris scissors
- Close lesion
- No closure needed if 3 mm punch or less used
- Healing by Secondary Intention for small excisions offers equivalent cosmetic results as with Suture
- Top lesion with Bacitracin and bandage
V. Complications
- Injury to underlying nerves or vessels
VI. References
- Pariser (1989) Modern Medicine 57:82-90
- Snell in Pfeninger (1994) Procedures, p. 20-6
- Zuber (2002) Am Fam Physician 65(6):1155-68 [PubMed]