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.