Skin Biopsies

There are a few different types of skin biopsies. The procedure is similar for many of them, although different tools are used. 

A tangential shave biopsy is used for superficial lesions and takes a tiny tissue sample from the skin’s upper portion. It is used to diagnose skin cancers, benign growths, and other conditions that develop near the skin’s surface.

A punch biopsy uses a small stainless steel bladed tool called a trephine, which looks like a small cookie cutter, explicitly created for this procedure. This allows the doctor to sample a small ‘plug’ of skin with all the layers allowing for a more comprehensive diagnosis. Punch biopsies are often required to diagnose many skin rashes. This is also the biopsy type of choice for diagnosing suspicious skin lesions that are highly concerning for melanoma. 

An incisional biopsy is a more extensive biopsy usually performed with a scalpel and often requiring stitches. It provides the doctor with a larger skin sample for analysis. 

An excisional biopsy is when the doctor removes the entire concerning skin lesion, usually with a scalpel. This is the most thorough type of biopsy and is performed when there is a high level of concern. Excisional biopsies are also done when the doctor is highly confident of the diagnosis and does not want to re-treat the lesion later with another procedure or when the doctor feels that a large sample is required for an accurate diagnosis of the skin lesion.

It is typically a minimally invasive procedure done by professionals in a clean environment under a local anesthetic. You can expect that you will have an open wound that will be bandaged or stitched up, and you will receive specific care instructions from your doctor. You will have to make sure to clean the wound with mild soap and water, as well as change the dressing daily until the wound is healed. Worsening pain 3-4 days after the biopsy should be quickly reported to the doctor, as this may indicate bacterial infection of the wound.

Typically, there is minimal pain. The most painful part of the procedure is numbing the area with the local anesthetic, which is typically lidocaine. You may experience some discomfort or pain afterward once the lidocaine wears off. Taking acetaminophen (Tylenol) and ibuprofen (if you are allowed to take it) will relieve any post-biopsy pain.