Skin biopsy is the removal of a small piece of tissue under local anesthesia from a lesion suspected of being malignant or from other dermatoses. One of three techniques may be used: shave biopsy, punch biopsy, or excisional biopsy. Shave biopsy uses a scalpel to slice a superficial specimen from the site. Punch biopsy removes an oval core from the center of a lesion down to the dermis or subcutaneous tissue. Excisional biopsy removes the entire lesion with a small border of normal skin.
Lesions suspected of being malignant usually have changed color, size, or appearance or fail to heal properly after injury. Fully developed lesions should be selected for biopsy whenever possible because they provide more diagnostic information than lesions that are resolving or in early developing stages.
Procedure and posttest care
Normal skin consists of squamous epithelium (epidermis) and fibrous connective tissue (dermis).
Histologic examination of the tissue specimen may reveal a benign or malignant lesion. Benign growths include cysts, seborrheic keratoses, warts, pigmented nevi (moles), keloids, dermatofibromas, and multiple neurofibromas.
Malignant tumors include basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. Basal cell carcinoma occurs on hair-bearing skin; the most common location is the face, including the nose and its folds. Squamous cell carcinoma most often appears on the lips, mouth, and genitalia. Malignant melanoma, the deadliest skin cancer, can spread through the body by way of the lymphatic system and blood.
Cultures can be used to detect chronic bacterial and fungal infections in which flora are relatively sparse.
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