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.

Figures

Figure 1

Compressing the skin of the arm reveals the direction of Langer's lines. A diamond-shaped excision is outlined with its long axis parallel to the wrinkle lines to facilitate closure.

Figure 2

Half of a razor is curved with thumb and forefinger to perform a shave biopsy.

Figure 3

The skin is stabilized with thumb and forefinger and stretched slightly perpendicular to the skin tension lines. A punch is held perpendicular to the skin, and is rotated into the skin with a firm, constant pressure.

Figure 4

Elliptical, diamond, and hexagonal excisions and sites of initial suture placement.