International Academy of Cosmetic Dermatology
A biopsy refers to the removal of a skin lesion, or a portion of that skin lesion. Once the tissue is obtained, histopathology of the frozen section or a permanent section is performed to establish the diagnosis.
An excisional biopsy removes the entire skin lesion for evaluation and may be performed using a scalpel or a single-edge razor blade; the tissue specimen can either include the full-thickness of the skin and extend into the subcutaneous fat or it can be a more superficial shave sample which typically includes only the upper layers of the skin and extends partial-thickness into the dermis or occasionally the underlying adipose tissue. An incisional biopsy only samples a portion of the skin lesion; either a scalpel, single-edge razor blade, or a punch tool (which provides a circular sample ranging in size from 2-mm to 8-mm) can be used to obtain the specimen.
Biopsies are usually preformed in the office. Local anesthesia is injected into the skin at the biopsy site. After the tissue specimen has been secured, local bleeding at the site is controlled with either a topically applied agent, an instrument that utilizes electric current to secure hemostasis, and/or sutures.
The biopsy site is then allowed to heal–either by second intention (by itself) or by suturing the edges together. Topical antibiotic ointment is sometimes suggested to be applied several times each day, until the area has completed healing or the sutures are removed or both.
Philip R. Cohen, MD
Bellaire, TX, USA