Skin Biopsy Procedures: How and Where to Perform a Proper Biopsy

1.1 Skin biopsy The skin biopsy is a relatively simple, but essential procedure in the managment of skin disorders. As a diagnostic method, skin biopsy is most commonly used in dermatology rather than in other medical specializations. The most common indication is to diagnose or exclude cutaneous malignancies. Properly performed, it may confirm a diagnosis, remove cosmetically unacceptable lesions, and provide definitive treatment for a number of skin conditions yielding a sample of skin for histopathological or other investigation. Before performing a skin biopsy it is necessary to take prior arrangements with a laboratory for sending specimens, particularly for specialised investigations such as direct immunofluorescence or molecular biology. Otherwise it would be better to send the biopsy to selectioned centers even far away because a wrong diagnosis is worse than a lack of diagnosis. It is also necessary a foolproof system for sending specimens, receiving and filing reports, documenting and executing action plans. Patients must give a well drafted, written consent form for invasive procedures. Skin biopsy techniques should ideally be quick and easy to perform, yielding specimens of high quality and adequate size while leaving the smallest possible tissue defect and a good cosmetic result. Skin biopsies can be performed with minimal risk in critically ill patients, and a timely skin biopsy may avoid other, more invasive procedures. Skin biopsies are infrequently performed by internist. This may involve lack of proficiency, or uncertainty regarding indications, choice of procedure, specimen handling, or subsequent wound care. Nevertheless, many dermatoses have nonspecific histopathology and biopsy cannot substitute for good clinical skills. There are few absolute controindications to skin biopsy, but all patients should be told that biopsies leave scars. A biopsy should not be done at an infected site, although occasionally infection may be the indication for the procedure. Inquiry should be made regarding allergies to topical antibiotics, antiseptics, local anesthetics and reaction to tape. Patient should be asked about systemic diseases, bleeding disorders, bleeding with previous surgery, and use of drugs known to interfere with hemostasis. There are several methods to perform biopsy: curettage, shave biopsy, punch biopsy, excisional biopsy.