Dermatology procedures: skin biopsy.
The procedures used most often for office-based skin biopsies are two types of shave biopsies, punch biopsy, and elliptical biopsy performed with a scalpel. Tangential shave biopsy is superficial and best suited to small, raised, benign lesions. Saucerization shave biopsy is deeper and is used for excisional biopsy of atypical nevi, for squamous and basal cell carcinomas, and as initial biopsy for suspected melanoma. Punch biopsy also removes deeper tissue and can be used to excise or sample a variety of lesions, including pigmented nevi. Elliptical biopsy using a scalpel is reserved for larger lesions not amenable to shave or punch biopsies. It is not necessary to discontinue anticoagulants before office-based skin biopsy is performed or to administer topical or systemic antibiotics. When sutures are used for wound closure, it is important for the sutures to have appropriate tensile strength. Multifilament sutures should be avoided in areas prone to infection, such as the feet. An important complication of skin biopsy is the development of hypertrophic and keloid scars, which are more common among patients with dark skin. Injection of triamcinolone or verapamil into a maturing scar can minimize the possibility of hypertrophic and keloid scars.
San Joaquin General Hospital Department of Family Medicine, 500 West Hospital Road, French Camp, CA 95231, tampsu@hotmail.com.
Tam
T
Nguyen