Skin Biopsies: What to Expect

During office visits at dermatology offices, providers often recommend performing a skin biopsy. Oftentimes when referring to the term biopsy, it may be a stressful thing to hear because biopsies are usually associated with cancer. However, biopsies are not always done just to diagnose cancer, but can also help diagnose different skin diseases such as dermatitis, hypersensitivity reactions, psoriasis and more. Although it might sound very scary or painful, skin biopsies are usually very tolerable and quick in-office procedures. 

Here at Beacon Skin, our primary goal is to make patients feel comfortable prior to and during dermatology treatments. This is what to expect during a skin biopsy:

1. Marking the biopsy site: First and foremost, the dermatology physician or physician assistant will use a skin marker to mark the exact site or area that needs to be biopsied. This helps ensure that no additional skin is removed if not needed. Marking the biopsy site also helps avoid taking a biopsy of the wrong lesion. Lastly, this helps aid the dermatologic surgeon in the future if additional treatment needs to be done depending on the biopsy results. 
2. Numbing the area of the marked biopsy site: Of course the dermatology provider or medical assistant will begin by cleansing the site with alcohol and/or iodine to make sure the skin is disinfected. Afterwards, the site will be injected with lidocaine to numb the area. This is typically the only time during the biopsy where the patient will feel some burning, stinging or pain. 
3. Removing or cutting the skin: there are definitely many different factors that come into play when a dermatology provider decides which biopsy method is the best diagnostic or therapeutic treatment. Oftentimes the type of removal is determined by the type of skin condition suspected or by the size or the growth of the biopsy site.
   1. Shave biopsy – this is by far the most common and fastest procedure done in the dermatology office. A dermablade or scalpel is utilized to shave a small piece of the top layer of the skin. 
   2. Punch biopsy – this is another common biopsy done when deeper layers of the skin need to be evaluated. During this procedure, a a dome-shaped tool is utilized to go through deeper layers of the skin. 
   3. Excisional biopsy – this is a less common type of biopsy but is used in office to get even deeper layers of the skin and to remove an entire lesion. This is especially an indicated procedure if the dermatology provider is worried about a possible melanoma. 
4. Treatment of the wound: First, pressure is applied to the wound with gauze. Next, the dermatology provider will usually cauterize to stop the bleeding, especially for a shaved biopsy. Lastly, if a punch or excisional biopsy is performed, then the provider will close up the wounds with stitches. The number of stitches and the type of stitches depends on the size of the biopsy site and the location on the body. 
5. Applying petroleum jelly to the wound: This is done after treating the wound and the dermatology provider will also recommend to continue daily petroleum jelly and a bandage for a week or two after the procedure. Having the wound moist will help with wound healing. 
6. Sending the skin specimen to a pathology lab: during the biopsy, the provider will place the specimen in a biopsy jar, and then it will be sent off to a lab to be examined by a dermatopathologist who will diagnose the sample and send the office the medical report within a week or two. 
7. Calling with the results: most importantly, the dermatology provider will go over the biopsy results to determine if the condition is benign or cancerous and if a follow up needs to be scheduled. Our office will give you a call as soon as we get the results and with the next best step! 

Hopefully this helps you feel more comfortable before going to a dermatology physician or physician assistant and with what to expect if a biopsy needs to be done! 

The information above is from the American Academy of Dermatology.