Types Skin biopsy

1 types

1.1 shave biopsy
1.2 punch biopsy
1.3 incisional biopsy
1.4 excisional biopsy
1.5 curettage biopsy
1.6 fine needle aspirate
1.7 saucerization biopsy

types
shave biopsy

a shave biopsy done either small scalpel blade or curved razor blade. technique user skill dependent, surgeons can remove small fragment of skin minimal blemish using 1 of above tools, while others have great difficulty securing devices. ideally, razor shave small fragment of protruding tumor , leave skin relatively flat after procedure. hemostasis obtained using light electrocautery, monsel s solution, or aluminum chloride. ideal method of diagnosis basal cell cancer. can used diagnose squamous cell carcinoma , melanoma-in-situ, however, doctor s understanding of growth of these last 2 cancers should considered before 1 uses shave method. punch or incisional method better latter 2 cancers false negative less occur (i.e. calling squamous cell cancer actinic keratosis or keratinous debris). hemostasis shave technique can difficult if 1 relies on electrocautery alone. small shave biopsy ends being large burn defect when surgeon tries control bleeding electrocautery alone. pressure dressing or chemical astringent can in hemostasis in patients taking anticoagulants.

punch biopsy

a punch biopsy done circular blade ranging in size 1 mm 8 mm. blade, attached pencil-like handle, rotated down through epidermis , dermis, , subcutaneous fat, producing cylindrical core of tissue. incision made punch biopsy closed 1 or 2 sutures. punch biopsies shaped ellipse, although 1 can accomplish same desired shape standard scalpel. 1 mm , 1.5 mm punch ideal locations cosmetic appearance difficult accomplish shave method. minimal bleeding noted 1 mm punch, , wound left heal without stitching smaller punch biopsies. disadvantage of 1 mm punch tissue obtained impossible see @ times due small size, , 1.5 mm biopsy preferred in cases. common punch size used diagnose inflammatory skin conditions 3.5 or 4 mm punch.

incisional biopsy

in incisional biopsy cut made through entire dermis down subcutanous fat. punch biopsy incisional biopsy, except round rather elliptical in incisional biopsies done scalpel. incisional biopsies can include whole lesion (excisional), part of lesion, or part of affected skin plus part of normal skin (to show interface between normal , abnormal skin). incisional biopsy yield better diagnosis deep pannicular skin diseases , more subcutanous tissue can obtained punch biopsy. long , thin deep incisional biopsy excellent on lower extremities allow large amount of tissue harvested minimal tension on surgical wound. advantage of incisional biopsy on punch method hemostasis can done more due better visualization. dog ear defects seen in incisional biopsies length @ least twice long width.

excisional biopsy

an excisional biopsy same incisional biopsy, except entire lesion or tumor included. ideal method of diagnosis of small melanomas (when performed excision). ideally, entire melanoma should submitted diagnosis if can done safely , cosmetically. excisional biopsy done narrow surgical margin make sure deepest thickness of melanoma given before prognosis decided. however, many melanoma-in-situs large , on face, physician chose multiple small punch biopsies before committing large excision diagnostic purpose alone. many prefer small punch method initial diagnostic value before resorting excisional biopsy. initial small punch biopsy of melanoma might severe cellular atypia, recommend wider excision . @ point, clinician can confident excisional biopsy can performed without risking committing false positive clinical diagnosis.

curettage biopsy

a curettage biopsy can done on surface of tumors or on small epidermal lesions minimal no topical anesthetic using round curette blade. diagnosis of basal cell cancer can made limitation, morphology of tumor disrupted. pathologist must informed type of anesthetic used, topical anesthetic can cause artifact in epidermal cells. liquid nitrogen or cryotherapy can used topical anesthetic, however, freezing artifacts can severely hamper diagnosis of malignant skin cancers.

fine needle aspirate

needle aspiration biopsy done rapid stabbing motion of hand guiding needle tipped syringe , rapid sucking motion applied syringe. method used diagnose tumor deep in skin or lymph nodes under skin. cellular aspirate mounted on glass slide , immediate diagnosis can made proper staining or submitted laboratory final diagnosis. fine needle aspirate can done small bore needle , small syringe (1 cc) can generate rapid changes in suction pressure. fine needle aspirate can used distinguish cystic lesion lipoma. both surgeon , pathologist must familiar method of procuring, fixing, , reading of slide. many centers have dedicated teams used in harvest of fine needle aspirate.

saucerization biopsy

a saucerization biopsy known scoop , scallop , or shave excisional biopsy, or shave excision. trend has occurred in dermatology on last 10 years advocacy of deep shave excision of pigmented lesion. author published result of method , advocated better standard excision , less time consuming. added economic benefit many surgeons bill procedure excision, rather shave biopsy. saves added time hemostasis, instruments, , suture cost. great disadvantage, seen years later, numerous scallop scars, , difficult deal lesion called recurrent melanocytic nevus . has happened many shave excisions not penetrate dermis or subcutanous fat enough include entire melanocytic lesion. residual melanocytes regrow scar. combination of scarring, inflammation, blood vessels, , atypical pigmented streaks seen in these recurrent nevi may result in dermatoscopic appearance of melanoma. when second physician later examines patient, or has no choice recommend re-excision of scar. if 1 not have access original pathology report, impossible distinguish recurring nevus severely dysplastic nevus or melanoma. procedure practiced, not unusual see patient dozens of scallop scars, many 20% of them showing residual pigmentation. second issue shave excision fat herniation, iatrogenic anetoderma, , hypertrophic scarring. deep shave excision either removes full thickness of dermis or diminishes dermal thickness, subcutanous fat can herniate outward or pucker skin out in unattractive way. in areas prone friction, can result in pain, itching, or hypertrophic scarring.