Skin biopsy techniques for the internist

Abstract

OBJECTIVE:To review three commonly performed skin biopsy procedures: shave, punch, and excision.DATA SOURCES: English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references. STUDY SELECTION:Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care. DATA EXTRACTION:Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques. DATA SYNTHESIS:Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis. CONCLUSIONS:Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.KEY WORDS: skin biopsy; shave biopsy; punch biopsy; excision biopsy; internists. J GEN INTERN MED 1998;13:46-54. The skin biopsy is a relatively simple, but essential procedure in the management of skin disorders. Properly performed, it may confirm a diagnosis, remove cosmetically unacceptable lesions, and provide definitive treatment for a number of skin conditions. Skin biopsies are unique because the lesion can be visualized, allowing for proper selection of biopsy site and technique. Skin biopsies can be performed with minimal risk in critically ill patients, and a timely skin biopsy may avoid other, more invasive procedures.Skin biopsies are infrequently performed by internists. 1 This may reflect lack of proficiency, or uncertainty regarding indications, choice of procedure, specimen handling, or subsequent wound care. The purpose of this review is to discuss in detail the three most commonly performed biopsy procedures: shave, punch, and excision. METHODSEnglish-language articles identified through a MED-LINE search using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and selected cross-references were reviewed. Articles were selected if they reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care and were relevant to internal medicine physicians wishing to learn skin biopsy techniques. BEFORE BIOPSY IndicationsIt...

Cutaneous changes of nephrogenic systemic fibrosis: Predictor of early mortality and association with gadolinium exposure

“…Each biopsy specimen demonstrated histologic evidence of NSF, lending validity to our skin scoring system. We intentionally limited our analysis for NSF to a noninvasive skin examination so as to maximize the number of patients who would participate and to avoid the less than trivial infectious complications of a full-thickness (often lower extremity) skin biopsy (20,21), especially given that the patients in this study universally had renal failure and a high prevalence of skin fibrosis and diabetes mellitus, which are known risk factors for surgical wound infection and poor wound healing (22)(23)(24). By not requiring a skin biopsy, we were able to achieve a 94% participation rate and to minimize selection bias.…”

Development of an intraoperative procedure for producing an autologous whole skin equivalent - prototype design and pilot resection force and tensile strength measurements

“…Tensile strength test: the subcutaneous adipose tissue is not always completely severed with every punching procedure, meaning that the whole skin islet can remain in the cutaneous covering or be pulled away from the punch blade when retracting the biopsy punch from the skin [12]. In an attempt to determine the force with which the whole skin islet is held by the subcutaneous tissue, the tensile resistance of the subcutaneous adipose tissue was determined experimentally in another test.…”

Collagenase cream in non-stitched skin wounds after punch biopsy

“…However, the medical doctor should have in mind that in some situations, small skin biopsies might cause difficult to the pathologist to establish a diagnose [6][7][8][9].…”