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  • A biopsy is an important tool to diagnose skin conditions and determine whether a skin lesion is benign or malignant.

  • There are several kinds of biopsies, including shave, punch, saucerization, incisional, excisional, and wedge. These different techniques and the medical indications for each technique will be discussed throughout this chapter.


  • Shave biopsy has good cosmetic results but may cause erythema that masks lesion borders. Unlike shave biopsy, punch biopsy allows for analysis of the depth of tumor without the consequence of erythema, thereby leaving tumor borders defined.

  • Excisional biopsies are both diagnostic and therapeutic; complete excision is used especially for melanoma.


  • A punch biopsy performed on the center of a lesion may be more advantageous than a shave biopsy.

  • Disposable punches are preferred as reusable ones may become dull over time and affect the histological analysis of specimens.

  • Circular excisional biopsy yields better cosmetic outcomes than the fusiform approach.

  • Putting a suture at the 12 o’clock position of a specimen from excisional biopsy provides orientation of the lesion and the patient’s body for the dermatopathologist.


  • Postoperative care for shave and punch biopsies is relatively uncomplicated.

  • Incisional biopsies, wedge biopsies, and excisional biopsies, in contrast, may lead to adverse consequences such as bleeding, infection, and scarring.


A biopsy is a diagnostic and sometimes therapeutic tool in which cells from a lesion are examined microscopically to determine whether the lesion is benign or malignant. A multitude of biopsy techniques exist, and using the appropriate biopsy technique is an essential step in ensuring an accurate diagnosis. Each technique has specific indications that consider the site, size, and type of lesion. Cosmetic outcomes must also be considered.

Biopsies of cutaneous lesions can be (1) incisional, partial, or incomplete biopsies in which part of the lesion is removed or (2) excisional or complete biopsies in which the entire lesion is removed.1 When cutaneous melanoma is diagnosed, excisional biopsies can include elliptical (fusiform) excisions, punch excisions, or saucerization.1 The different types of biopsies discussed in this chapter will include techniques that are commonly used for skin cancers: shave, saucerization, punch, excisional, incisional, and wedge. It is important to not only understand the types of techniques discussed in this chapter but also to recognize the diseases for which each technique is indicated.


A complete history and physical must be taken before performing a biopsy to identify any potential drug allergies and to elicit any information that would indicate a patient is at increased risk for experiencing coagulation problems or an infection (eg, any artificial heart valves or joints). Prebiopsy photographs, which should include anatomic landmarks, can also aid in making a clinical and pathologic diagnosis and prevent wrong-site surgery in the event that future treatment is warranted....

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