Biopsy and Excision

Of rashes, moles, other benign and malignant skin lesions   

Biopsy and surgical excision are procedures in which all or a portion of a skin lesion is removed and when indicated, sent to a pathologist to render a diagnosis. SKIN Specialists performs these procedures as an in-office procedure under local anesthetic, and results are available in 4 to 10 days. A biopsy is necessary to distinguish between different types of rashes or skin lesions; or to confirm whether skin cancer is present and if so, to obtain information on the type of skin cancer to determine the most appropriate treatment.     

SKIN Specialists utilizes the following procedures dependent on the suspected diagnosis of the skin lesion:    

• Punch biopsy is used when a full-thickness skin specimen is needed.  A circular blade is rotated down through the epidermis and dermis and into the subcutaneous fat, to obtain a cylindrical core of tissue sample. More than one punch biopsy may be required depending on the condition being investigated. A stitch may be required; however, if the wound is small, it may heal adequately without a stitch.   
• Incisional biopsy, also known as a wedge, is used when a larger or deeper piece of skin is needed to make a correct diagnosis. A piece of skin is cut out with a scalpel blade. Stitches are usually required after this procedure.   
• Curettage excision is used on the surface of tumors or on small epidermal lesions with minimal to no topical anesthetic using a round curette blade. A curette is a metal instrument with a long slender handle having a circular tip that is sharp on one side.   
• Shave excision is used when it is suspected that the skin lesion only affects the top layers of the skin (epidermis and dermis). A superficial slice of skin is taken from the area with a small scalpel. There are usually no stitches required but there will be a small scab that should heal within weeks depending on the skin lesion involved.   
• Surgical excision may be used to establish a pathological diagnosis and for therapeutic purposes and usually requires stitches. With this procedure, the entire lesion or tumor is removed along with a small amount of normal-looking skin, which is called a margin. Depending on the suspected diagnosis of the skin lesion, the specimen may be sent to a pathologist to confirm diagnosis and if a skin cancer, whether the margins are clear. If not clear, another surgery must be scheduled. Surgical excision is the ideal method of diagnosis of melanoma skin cancers and atypical nevus and is the most common treatment for their removal. Referral to another surgical specialist may be indicated based on the size, location and pathology of the lesion.     

WHAT IS INVOLVED WITH A BIOPSY OR EXCISIONAL PROCEDURE?  

A small injection of a local anesthetic such as lidocaine is given into the skin to make the area numb. This usually stings momentarily but the skin quickly becomes numb. Patients may feel a pushing sensation in the area where the skin biopsy is being performed but there should not be any pain. You should tell the doctor if you experience pain during the biopsy. You may have stitches depending on the type of procedure. If so, you will be told when to return to the office for removal. Depending on the type of procedure, a dressing may be applied to the surgical site. If so, the dressing should be left in place for the first 24 hours. Additional instructions will be provided at the time of surgery.   If a specimen is sent to a pathologist, arrangements will be made to tell you the results. It usually takes about 1 week to obtain the results from the pathology laboratory, but can sometimes take longer if special stains are required. There will be a small scar left after the skin biopsy or excision site has healed.