Surgical Skin Procedures
What is a skin biopsy?
If a doctor is concerned about a mole or growth or any other lesion on your skin, a biopsy may be done. This involves removing a part or all of the skin lesion and then sending it to a histo-pathologist to assist in diagnosing what it is. The diagnosis is important as this may confirm a cancer and assist in determining the correct treatment and follow up care. There are different types of biopsy and your doctor will decide what is most suitable. The area of the biopsy is usually injected with local anaesthetic (which stings transiently) before the procedure is done. After the procedure, a dressing will usually be applied to the site of the biopsy.
A PUNCH BIOPSY is quick to perform, convenient, and only produces a small wound. The tissue that is taken enables the pathologist to evaluate the full thickness of skin.
A disposable skin biopsy punch tool is used. It has a round stainless steel blade ranging from 2–8 mm in diameter. The doctor holds the instrument perpendicular to the skin and rotates it to pierce the skin and removes a cylindrical core of tissue which includes epidermis, dermis and sometimes, subcutaneous tissue. A suture may be used to close the wound, or, if the wound is small, it may heal adequately without it. A further surgical procedure is often required - depending on the diagnosis and how much of the lesion was excised in the biopsy.
An EXCISION BIOPSY refers to the complete removal of a skin lesion with a small margin of surrounding skin which is then closed with sutures. This procedure usually results in complete clearance of the lesion and allows the pathologist to make a diagnosis. Smaller lesions are most often removed in an elliptical shape which is the closed with sutures. Larger excisions may need to be repaired using a skin flap (moving adjacent skin to cover the wound) or skin graft (taking skin from elsewhere on the body to cover the wound).
A SHAVE BIOPSY may be done, particularly if the skin lesion is superficial. A shave of skin is taken using a scalpel or special shave-biopsy instrument. The depth of a shave biopsy will vary depending on the lesion biopsied. No stitches are required. The wound is similarly to a skin graze and forms a scab that.
Curettage & Cautery
A skin curette may be used to scrape off a superficial skin lesion and the curettings may be sent for histopathology. Sometimes a wound may be curetted after a shave biopsy to ensure that no unhealthy tissues remains. This is often done with cauterisation to assist in clearing all unhealthy tissue that could have been missed by the shave procedure. This generally results in treatment and diagnosis in a single procedure.
Skin Flaps & Grafts
At times a more complicated surgical procedure - such as a full or partial thickness skin graft or flap - is required to close the defect left from removing a skin lesion. Details of such procedures will be explained and discussed if required.
In order to optimise healing & minimise scarring it is important that wound care is meticulous. You will be given clear instructions regarding the care and follow up of your surgical wound. In general, all wounds should be kept dry and covered. The dressing may be changed after a couple of days. Sutures need to be removed 5-14 days after the procedure depending on the location.
A skin biopsy is usually a simple straightforward procedure and although complications are uncommon, they may occur. These include bleeding, infection, delayed healing, wound breakdown, scarring & persistence or recurrence of the lesion.