Skin Biopsy

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What is Skin Biopsy

Your doctor may want to obtain a sample of skin in order to diagnose diseases of the skin, such as those caused by skin tumors, other types of growths, infections, or other skin conditions. This procedure is called a skin biopsy.

A biopsy of a lesion of the skin can help your doctor tell the difference between a skin cancer and a benign, or noncancerous, lesion. The skin sample obtained during a biopsy is sent to a laboratory for examination under a microscope.

How the procedure is performed:

  • In a punch biopsy, a sharp cookie cutter - like instrument is used to remove a small cylinder of skin. Sometimes stitches are necessary to close this type of biopsy wound.
  • A shave biopsy is a procedure where the outermost part of a lesion can also be removed with a scalpel. No suturing is required to close this wound.

Risks of Skin Biopsy

You should discuss with your doctor the following potential risks and complications of the biopsy procedure. You may need to sign a consent form before the procedure is performed.

Possible risks include these:

  • Bleeding from the biopsy site
  • Pain
  • Local reaction to the anesthetic
  • Infection
  • Healing problems - If you tend to form large, overgrown scars (keloids), you have an increased chance of forming a similar lesion over the biopsy site. Smoking and some chronic medical conditions such as diabetes affect the healing ability of the skin.

Skin Biopsy Preparation

Skin biopsy is routinely done in the doctor’s office. You may be asked to change into a gown or remove an article of clothing so that the area of suspect skin can be more easily seen and removed.

  • Tell your doctor if you have any allergies to medications, and especially if you have had any reactions to local anesthetics, such as lidocaine or novocaine, or to iodine cleaning solutions, such as Betadine.
  • Inform your doctor if you are taking any medications, including over-the-counter drugs, street drugs, or herbal or nutritional supplements.
  • Tell your doctor if you have any bleeding problems or if you are pregnant.

During the Skin Biopsy Procedure

  • The site of the skin biopsy may be cleaned with an iodine-type solution, with alcohol, or with a sterile soap solution. After the skin has been cleaned, sterile towels are placed around the area. Do not touch this area once it has been cleaned and prepared. Many physicians do not go through this process since the chance of an infection after a skin biopsy is very small.
  • A local anesthetic, usually lidocaine, is injected into the skin to make it numb. You will feel a brief prick and stinging sensation as the medicine is injected. After the skin is numb, your doctor performs the biopsy.
  • The tissue that is removed is sent to the laboratory for analysis by a pathologist.
  • If needed, stitches are placed to close the wound.

After the Skin Biopsy Procedure

  • Your doctor will put a bandage over your biopsy site. Keep this bandage dry. You may be advised to wash the wound, apply antibacterial ointment or petrolatum (Vaseline) and change the bandage daily.
  • If you have stitches, you need to keep the area clean and dry. Follow instructions regarding when and how to wash the wound. Stitches on the face are removed in 5-8 days. Stitches placed elsewhere on the body are removed in 7-14 days. Adhesive strips are left in place for 10-21 days.
  • If you have pain at the biopsy site, talk with your doctor about medication to relieve it. In most cases, discomfort is minimal and requires nothing more than an over-the-counter pain medication.
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Questions to Ask Your Doctor Before a Biopsy

What are the types of biopsies?

There are several types of biopsies:

  • Excisional biopsy. If your doctor finds an area of interest or a suspicious finding (for example, an enlarged nevus, or mole), often an excisional biopsy is performed to remove the area in question in its entirety during the biopsy.
  • Incisional biopsy. An incisional biopsy refers to removal of only a portion of the area of interest (for example, sampling of a small fragment of tissue from a larger breast lump).
  • Fine needle biopsy. A fine needle biopsy is used to remove cells or fluid by suctioning through a long, thin needle.
  • Core needle biopsy. During a core needle biopsy, the doctor inserts a special needle through a skin incision that removes a very thin, cylindrical piece of tissue.

Next Steps after Skin Biopsy

Your doctor needs to see you again to remove the stitches and to give you the results of the pathology report. If no stitches are placed, he may ask you to get in touch by phone so he or she can discuss the results for you.

When to Seek Medical Care for Skin Biopsy Complications

Call your doctor if you have worsening pain, spreading redness around the site, bleeding from the wound, fever (temperature greater than 100.4°F), or other concerns.

Go to a hospital's emergency department if you have bleeding from the site that will not stop with gentle pressure after 30 minutes, if you have a thick discharge (pus) from the wound, or if you have a high fever.

Medically reviewed by Norman Levine, MD; American Board of Dermatology

REFERENCES:

1. Alguire PC, Mathes BM. Skin biopsy techniques for the internist. J Gen Intern Med. Jan 1998;13(1):46-54. [Medline].
2. Arpey CJ. Biopsy of the skin. Thoughtful selection of technique improves yield. Postgrad Med. Mar 1998;103(3):179-82, 185-9, 193-4. [Medline].
3. Haugstvedt A, Larsen TE, Haheim LL. [Biopsy in non-neoplastic skin diseases]. Tidsskr Nor Laegeforen. Mar 10 1998;118(7):1038-40. [Medline].
4. Leslie T. Skin biopsy: how to do it. Br J Hosp Med. Oct 1-14 1997;58(7):341-2. [Medline].
5. Lindsay G. Away from it all?. Nurs Times. Oct 11 1979;75(41):1775. [Medline].
6. Orengo I, Katta R, Rosen T. Techniques in the removal of skin lesions. Otolaryngol Clin North Am. Feb 2002;35(1):153-70, vii. [Medline].
7. Weisberg NK, Becker DS. Potential utility of adjunctive histopathologic evaluation of some tumors treated by Mohs micrographic surgery. Dermatol Surg. Nov 2000;26(11):1052-6. [Medline].

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