Biopsy is the removal of a small piece of tissue from the skin for microscopic examination. Partial or full thickness of skin over the lesion is removed for evaluation.
OVERVIEW
- Punch biopsy is used for full and partial dermal lesions such as
- Basal cell carcinoma
- Squamous cell carcinoma
- Actinic keratoses
- Seborrheic keratoses
- Lentigo (freckles)
- Lipomas
- Melanomas
- Nevi
- Warts—verruca vulgaris
RATIONALE
- To confirm etiology of lesion for treatment
- To establish or confirm a diagnosis for treatment and/or intervention
INDICATIONS
- Partial- or full-dermal-thickness lesion not on the face, eye, lip, or penis
CONTRAINDICATIONS
- Lesion on eyelid, lip, or penis, REFER to a physician.
- Infection at the site of the biopsy
- Bleeding disorder
- Lesions that are deep or on the face, REFER to a physician.
- Informed consent required
PROCEDURE
Punch Biopsy
Equipment
- Antiseptic skin cleanser
- Drape—sterile
- Gloves—sterile
- Disposable biopsy punch
- Pickups—sterile
- Scissors—sharp for the fine tissue—sterile
- 3-mL syringe
- 27- to 30-gauge, ½-inch needle
- 1% lidocaine
- Container with 10% formalin
- 4 × 4 gauze
- Nonstick dressing (Adaptic or Telfa)
- Kling
- Tape
- Steri-Strips (if biopsy will be greater than 4 mm) or one suture
Procedure
- Position the client so that the area to be biopsied is easily accessible.
- Cleanse the skin with antiseptic skin cleanser.
- Put on gloves.
- Drape the area to be biopsied.
- Anesthetize with 1% lidocaine.
- With the thumb and index finger, spread the skin to apply tension opposite natural skin tension lines. This allows a more elliptical-shaped wound for easy closure.
- Apply biopsy punch to skin, rotate per manufacturer’s directions, and remove the punch
- With pickups, pull up loosened skin.
- Cut with scissors, and place tissue in tissue container of 10% formalin.
- If less than 2 to 3 mm, apply nonstick dressing and pressure dressing.
- If greater than 4 mm, apply Steri-Strips and cover with 4 × 4 gauze.
- Apply Kling and secure with tape.
Client Instructions
- Keep dressing clean, dry, and in place for 48 hours to decrease the chance of bleeding and oozing.
- Avoid touching or contaminating the area biopsied.
- To prevent the chance of infection, take cephalexin (Keflex) 500 mg three times per day or amoxicillin (Amoxil) 500 mg twice a day for 5 days.
- Some redness, swelling, and heat are normal. Return to the office if symptoms of infection occur, such as
● Yellow or green drainage
● Red streaks
● Pain
● Elevated temperature
- Take acetaminophen (Tylenol) or ibuprofen (Motrin) every 4 to 6 hours as needed for pain.
BIBLIOGRAPHY
De Vries HJ, Zeegelaar JE, Middelkoop E, et al. Reduced wound contraction and scar formation in punch biopsy wounds. Native collagen dermal substitutes. A clinical study. Br J Dermatol. 1995;132(5):690–697.
Zuber TJ. Ingrown toenail removal. Am Fam Physician. 2002;65(12):2547–2550.
