title: The Ram Relaxation Technique: A Painless Biopsy Method. A Shave Biopsy Approach Without Injectable Anesthesia or Needles.
abstract: BACKGROUND
  Shave skin biopsies are essential procedures wherein physicians diagnose dermatologic lesions. The protocol for skin biopsies entails a lidocaine/epinephrine injection. This study suggests an alternative, novel method of performing a shave biopsy that avoids pain, needles, and injectable anesthesia, termed the Ram Relaxation Technique (RRT).
  
  
  OBJECTIVE
  To present a new technique that physicians may chose to form when faced with dermatological biopsies that are painless and needle free.
  
  
  METHODS
  Randomly selected, patients were presented to the authors' offices with abnormal skin lesions that required a shave biopsy. The patients were offered the choice of having an anesthetic injection (1% lidocaine, 1:100,000 epinephrine) or the alternative method (RRT) before the biopsy. Twenty patients (n = 20, 10 men, 10 women) chose the alternative method (RRT) and were the focus of this study. These patients who chose RRT were asked to scale their pain on a scale of 0 to 10 (0 = no pain, 1-3 = mild, 4-6 = moderate, and 7-10 = severe pain).
  
  
  RESULTS
  Fourteen of the 20 patients stated that they experienced no pain (0), 5 experienced mild pain, and 1 patient experienced moderate pain.
  
  
  CONCLUSIONS
  This study demonstrates an alternative and nearly pain-free method for superficial shave biopsies of the skin for certain patients in the appropriate clinical setting with the appropriate, superficial papule lesions. Dermis lesions, melanocytic lesions, and macular lesions are not ideal candidates given the risk for misdiagnosis, and more pain, respectively.
authors.affiliation: *Western University of Health Sciences, COMP, Pomona, California and Dermatology Department, Apple Care Physicians Group, Granada Hills, California; †Oakland University, William Beaumont School of Medicine, Rochester, Michigan; ‡Keck School of Medicine, Dermatology, Los Angeles, California.
authors.forename: Jacquiline R
authors.initials: JR
authors.lastname: Habashy
authors.forename: Benjamin
authors.initials: B
authors.lastname: Ghiam
authors.forename: Ramin
authors.initials: R
authors.lastname: Ram
mesh_terms: D000772:Anesthesia, Local; D001706:Biopsy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009339:Needles; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D012063:Relaxation; D012867:Skin / Q000473:pathology*