Skin biopsy

Skin biopsy is used to rule out various skin diseases and also to remove skin lesions. The procedure is advised by a doctor for diagnosis of some of the following problems:

• Actinic keratosis
• Dermatitis
• Eczema
• Psoriasis and other inflammatory skin diseases.
• Bullous pemphigoid and other skin disorders consisting of blisters.
• Skin tags
• Warts
• Skin infections bacterial or fungal.
• Skin cancers such as melanoma, squamous cell carcinoma and basal cell carcinoma.
• Suspicious moles and other abnormal small growth on the skin.
• Abnormal and persistent skin rashes.
• Keloids
• Open sores
• Rough or scaly skin
• Any abnormal change in the color of the skin.

A biopsy is very helpful in diagnosing skin cancer at a very early stage and hence, prevent it from spreading. Skin biopsy is usually a small, minimally invasive procedure performed in the outpatient facility (doctor’s room).

Skin biopsy is usually a safe procedure but may have some associated complications, as mentioned below.

• Bruising
• Swelling
• Bleeding
• Redness
• Keloids
• Infections
• Scarring
• Allergic reaction s to the topical medications.
• There might be a slight pain or a burning sensation when local anesthesia is given.

Before the procedure:

 It is important to inform the doctor in case of the following:

• Bleeding disorders
• If the patient is taking blood-thinning medications such as aspirin, warfarin or heparin.
• Past experience of excessive bleedings from any medical procedures.
• History of skin infections e.g. impetigo.
• If a patient is diabetic, it is important to inform the doctor before the procedure.
• Inform the doctor about any past allergies or surgeries, if any.
• If any medications are going on after an organ transplant.

The doctor takes a complete medical history and physical examination test before performing the procedure. The patient may be asked about any past surgeries, allergies to any medicines, previous personal history and family history of skin diseases. In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.

The patient is asked to avoid smoking before the procedure and is asked to change into a hospital gown or undress some portion, depending upon the area to be treated, during the procedure.

During the procedure:

The doctor or the nurse cleans the affected area from where the skin biopsy is to be taken. Sometimes, the doctor uses a marking pen or surgical marker to outline the area to be taken for the biopsy. A local anesthesia is then administered into the patient to numb the area before taking out the tissue sample. The local anesthesia is given with the help of an injection which may cause slight pain and burning sensation for a few seconds when administered.

The site from where the skin biopsy is to be taken, then becomes numb and no pain or discomfort is felt during the procedure.

There can be different types of skin biopsy done and depending on the type of procedure, different steps would be followed, as mentioned below

• Shave biopsy – In this type, the doctor uses a double-edged, sharp razor-like knife or scalpel to make a cut on the affected skin. The depth of the cut depends upon the affected part of the body and the type of biopsy performed. Shave biopsy may cause bleeding which can be stopped by applying topical medicine or a combination of manual pressure and medicine on the site of biopsy.
• An excisional biopsy or a punch biopsy – In such types of skin biopsies, an affected skin or lump is removed completely along with a small part of the surrounding normal tissue down through or to the fatty skin layer. This deep incision is then closed by sutures followed by an adhesive bandage or dressing over the biopsy site, in order to prevent bleeding and protect the wound from getting infected.

The entire skin biopsy procedure takes approximately 15 minutes to complete inclusive of preparation time and post-procedure, dressing time.

After the procedure:

• The doctor advises the patient to keep the dressing or the bandage over the biopsy site for at least 24 hours.
• Sometimes, the biopsy site starts bleeding when the patient goes home. This is common in cases, where patients take blood-thinning medicines. In such a scenario, the patient should apply manual pressure over the bleeding site directly, for at least 10 to 20 minutes. The bleeding will stop after this, but if the bleeding does not stop, the patient is advised to call the doctor immediately.
• After all the biopsies, there is a small scar left. In some people, the scar is very prominent and raised. The risk of getting such a scar is high when the biopsy site is on the neck, back or chest. Initially, the color of the scar remains pink, and further it changes to white or brown. The scars after the biopsy fade away eventually.
• The doctor advises the patient not to stretch the biopsied area at all. The site should be handled very carefully. If the patient stretches the skin somehow, there can be bleeding from the site, which can further lead to enlarged scar formation.
• Full healing of the biopsy site may take many weeks. The site gets healed properly within 2 months. In case, the biopsy site is on the feet or leg, then it may heal slowly as compared to the other parts of the body.

For the effective and fast healing of the biopsy sites, the patients are advised to follow the followng tips and techniques.

• It is important to wash hands properly with soap and water, before touching the site.
• The doctor advises to wash the biopsy site properly with soap and water. If the site is in the scalp, use shampoo to clean.
• Rinse the biopsy site well with water to remove all soap.
• Pat the biopsy site with a clean towel to make it dry completely, as any moisture may cause pus and lead to delayed healing.
• Cover the biopsy site properly with a clean adhesive bandage, which will allow the site some ventilation and prevent it from dust thereby getting infected.
• It is important to take good care of the biopsy site especially until the sutures are removed in case of excisional and punch biopsies. In the case of a shave biopsy, the patient needs to take care of the site until the skin is healed properly.

After the procedure of skin biopsy completes, the patient is allowed to change into normal clothes and is also allowed to go back home the same day of the procedure. The patient can return back to normal routine activities after the procedure.

After the small tissue sample is taken, the doctor sends the sample to the laboratory for further detailed analysis of the skin problem. The biopsy report may take some days or even weeks, depending upon the type of skin biopsy, skin problem, and the lab procedures. Some biopsy samples are sent for genetic or metastasis testing also, which may cause of further delay of few months, before the reports are available from the lab.

Once the report is available, the doctor discusses the report in detail with the patient. The patient is advised to get a family member along, during the report consultation. If the biopsy report shows results with squamous cell carcinoma or basal cell carcinoma, the affected skin or cancerous part can be removed during the biopsy or soon after. In such a scenario, no other specific treatment is required. If the patient is diagnosed with melanoma, then the doctor advises going for some more tests, in order to see if cancer has spread or not. In case of such a diagnosis, the doctor suggests special treatment plans for the patient individually.

The doctor should be informed immediately if any of the following conditions occur at home after the skin biopsy is done:

• Swelling, bruising or bleeding from the biopsy site.
• Severe pain or discomfort in the treated site.
• Any signs like fever, drainage or severe redness.
• Pus formation
• Irritability or severe itching on the biopsy site (near sutures).

Q1. What is done to the skin tissue sample after the biopsy procedure?

A1. When the biopsy is done, the tissue sample is extracted from the affected site. Following are the steps followed after the biopsy procedure:

• The sample is sent to the lab.
• The tissue sample is fixed in a special solution in the lab and very fine and thin tissue sections are cut from the sample.
• These sections are placed on the microscope slides and the slides are stained and ready for the doctor or pathologist to view. Sometimes, to view specific antibodies and certain disease markers, special stain solutions are used.
• Normal routine biopsy testing can typically take 2 to 3 days. However, special staining techniques may take quite a long time before the report can be readied for the sample.