Skin biopsy

Diagnosis is established by taking a small piece of tissue under local anesthesia from suspicious spots, rashes or masses on the skin and submitting it for pathological examination.

Indication

• Moles and lesions suspicious for melanoma, basal cell carcinoma or squamous cell carcinoma
• Inflammatory skin diseases such as psoriasis, eczema or lichen planus that are unresponsive to treatment or atypical in course
• Diagnosis of autoimmune skin diseases (pemphigus, bullous pemphigoid, lupus erythematosus)
• Indeterminate or rapidly growing subcutaneous masses and cysts
• Suspicion of vasculitis (vessel inflammation) or granulomatous diseases
• Differential diagnosis of alopecia (hair loss) on the scalp
• Confirmation of infectious diseases such as fungal infections, leishmaniasis (cutaneous leishmaniasis) or tuberculosis

Preparation

• If blood-thinning medications (warfarin, aspirin, clopidogrel) are used, they are stopped or dose-adjusted with physician approval
• Known drug and local anesthetic allergies must be reported to the physician
• The area should be moist, clean and free of makeup before the procedure
• Biopsy may be postponed if there is active infection or skin inflammation
• Driving after the procedure is generally not problematic; however, rest is planned for procedures involving a load-bearing extremity

How it's performed

1. The biopsy area is cleaned with antiseptic solution and bordered with sterile drapes
2. Local anesthetic (usually lidocaine) is injected under the skin with a small needle; pain stops within a short time
3. Depending on the lesion type, a 'shave' (superficial), 'punch' (cylindrical die) or 'excisional' (full removal) method is selected
4. The tissue sample is sent to pathology; direct immunofluorescence or culture may be performed if needed
5. Depending on wound size, 1-2 sutures are placed or the wound is closed with tape; bleeding control is performed
6. Dressing and care instructions are provided in writing

Post-procedure

• The pathology result is usually available within 5-10 business days; the result is reviewed together with the patient
• Sutures are removed after 5-14 days depending on the area
• The wound area heals with daily antiseptic care and keeping it dry
• Depending on the result, additional surgery (wide excision), treatment (cream, light therapy) or follow-up is planned
• If a biopsy was performed for a suspicious mole, regular skin screening is continued

Risks

• Temporary pain, tenderness and slight bleeding at the procedure site may be expected
• The risk of infection is around 1-2% and is reduced with proper care
• Scar formation is unavoidable; its size depends on the location of the lesion and the skin type
• Risk of prominent scar formation is increased in keloid-prone individuals
• Local anesthetic allergy is rare; signs of allergic reaction should be reported to the physician
• Repeat biopsy may be needed if the sample is insufficient in superficial biopsies

FAQ

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