Punch biopsy what is it

It is also used to diagnose precancerous skin conditions and non-cancerous skin tumours or conditions. A punch biopsy is often used for large tumours on the skin or on a thin, moist layer of tissue that lines some organs and cavities mucosa. Most side effects of a punch biopsy are temporary. They may include: soreness or tenderness at the biopsy site a small amount of bleeding wound infection scarring.

The biopsy sample is sent to a lab. A pathologist a doctor who specializes in the causes and nature of disease examines the sample. The pathology report describes the types of cells found in the sample and if the cells are normal or abnormal. An abnormal result may mean: an infection a skin condition such as psoriasis or eczema a non-cancerous skin tumour such as a mole a precancerous condition of the skin such as actinic keratosis or lentigo maligna a cancer such as basal cell carcinoma or squamous cell carcinoma.

If an abnormality or cancer is found, your doctor will decide if you need more tests, treatment or follow-up care. In some cases, a punch biopsy completely removes the tumour and no other treatment is needed. Home Treatments Tests and procedures Punch biopsy. Thank you for sharing our content. A message has been sent to your recipient's email address with a link to the content webpage. Your name: is required Error: This is required. Your email: is required Error: This is required Error: Not a valid value.

Send to: is required Error: This is required Error: Not a valid value. On this page What is a punch biopsy? What are the benefits of a punch biopsy? Are there any alternatives to a punch biopsy? What does the procedure involve? What complications can happen? How soon will I recover? Related information on Australian websites This page will give you information about a punch biopsy of a skin lesion.

What is a punch biopsy? A punch biopsy involves removing a small piece of skin using a circular blade called a punch. A punch biopsy of a skin lesion. Back To Top. General search results. Skin biopsy is the most important diagnostic test for skin disorders. In selected patients, a properly performed skin biopsy almost always yields useful diagnostic information. Some authors believe that most errors in dermatologic diagnosis occur because of failure to perform a prompt skin biopsy.

Punch biopsy is considered the primary technique to obtain diagnostic, full-thickness skin specimens. It is performed using a circular blade or trephine attached to a pencil-like handle. The instrument is rotated down through the epidermis and dermis, and into the subcutaneous fat. The punch biopsy yields a cylindrical core of tissue that must be gently handled usually with a needle to prevent crush artifact at the pathologic evaluation. Large punch biopsy sites can be closed with a single suture and generally produce only a minimal scar.

Because linear closure is performed on the circular-shaped defect, stretching the skin before performing the punch biopsy allows the relaxed skin defect to appear more elliptical and makes it easier to close. The skin is stretched perpendicular to the relaxed skin tension lines, so that the resulting elliptical-shaped wound and closure are parallel to these skin tension lines. Punch biopsy of inflammatory dermatoses can provide useful information when the differential diagnosis has been narrowed.

Cutaneous neoplasms can be evaluated by punch biopsy, and the discovery of malignancy may alter the planned surgical excision procedure. Routine biopsy of skin rashes is not recommended because the commonly reported nonspecific pathology result rarely alters clinical management. Sterile gloves Some physicians choose to perform the procedure using the nonsterile gloves that were used to administer the anesthesia. Sterile fenestrated drape Some physicians choose to perform the procedure without a covering drape.

Orienting a punch biopsy. A Just before performing the biopsy, the lines of least skin tension are determined. B The skin is stretched 90 degrees perpendicular to the lines of least skin tension using the nondominant hand. The punch biopsy is performed. Following relaxation of the distending hand, C the wound has an elliptical shape that can be closed with sutures parallel to the lines of least skin tension. The area to be biopsied should be selected.

Commonly selected sites are the most abnormal-appearing site within a lesion or the edge of an actively growing lesion. The skin is cleansed with povidone-iodine solution and anesthetized with 2 percent lidocaine with epinephrine. A gauge needle is used to administer the anesthetic to limit discomfort.

The lines of least skin tension should be identified for the area to be biopsied. For example, on the arm, these lines run perpendicular to the long axis of the extremity. The incision line created by the suturing after the biopsy is performed will be oriented parallel to the lines of least skin tension.

Physicians who cannot recall the line orientation for a specific body area should consult the widely published drawings of these lines. The skin surrounding the biopsy site is stretched with the thumb and index finger of the nondominant hand Figure 1. The skin is stretched perpendicular to the lines of least skin tension. When the skin relaxes after the biopsy is performed, an elliptical-shaped wound remains that is oriented in the same direction as the lines of least skin tension.

On the arm, the skin is stretched along the long axis of the extremity. The punch biopsy instrument is held vertically over the skin and rotated downward using a twirling motion created by the first two fingers on the dominant hand Figure 2. Once the instrument has penetrated the dermis into the subcutaneous fat, or once the instrument reaches the hub, it is removed.

The cylindrical skin specimen is elevated with the anesthesia needle held in the non-dominant hand. The use of forceps is discouraged because these instruments frequently cause crush artifact. Scissors held in the dominant hand cut the specimen free from the subcutaneous tissues. The cut is made below the level of the dermis. The wound is closed, if necessary, with one or two interrupted nylon sutures: 5—0 nylon is used for most nonfacial areas, and 6—0 nylon for most facial areas.

The suture generally creates good hemostasis, and antibiotic ointment and a bandage are then applied. Results from a punch biopsy revealing malignancy usually mandate further surgical intervention. If the lesion is a thin melanoma less than 0. If the lesion is a thicker melanoma, the family physician may consider referral to a melanoma center for excision and sentinel node removal following dye injection. Other Skin Malignancy.

Basal cell carcinoma and squamous cell carcinoma can be completely excised with a 4- to 6-mm margin of normal appearing skin.

The larger margin 6 mm is recommended for larger tumors, recurring tumors or tumors on high-risk sites such as the nose, ears and eyelids.

Other, less common tumors, such as dermatosarcoma protuberans, may require referral for more extensive surgical management.