DERMATOLOGY

Skin biopsy procedures are frequently used methods for both diagnosis and treatment. These methods are punch biopsy, incisional (partial removal of the lesion) or excisional (complete removal of the lesion) biopsy, shave excision depending on the size of the lesion. Your doctor will decide according to the size, location, depth of the lesion and whether it is benign or malignant. The issue that should be noted before the explanation about these transactions is the common points in the transactions. Pre-procedure preparation, anesthesia applied for the procedure and post-procedure wound care include common points. Your doctor will inform you in detail about this.

Transaction Applications

A) Before Application

1) The practice room should provide the necessary conditions for minor surgical interventions (equipment, cleaning, etc.), standard preoperative evaluation should be done.

2) Written and verbal information is given to the patient about the procedure, its stages and complications, and an informed consent form is signed and obtained. For those under the age of 18, the signature of their legal guardian is taken.

4) The recording and photographing of the patient is done carefully.

B) Application

1) The biopsy area is marked with a pencil.

2) Local anesthesia is applied. The effect of local anesthesia is achieved within 2 minutes. It takes approximately 7-15 minutes for the vasoconstrictive effect to be achieved in heavily bleeding areas.

3) The skin area to be biopsied is cleaned with an antiseptic solution, covering an area of ​​5 cm from the environment. Sterile perforated dressing is draped over the area.

4) At the stage of separating the biopsy material from the tissue, the tissue sample should be gently held without damaging it, and the biopsy material should be clarified by applying a slight pressure to the surrounding tissue.

5) It is generally preferred to close the defect primarily by suturing. Putting one or two epidermal sutures not only accelerates healing, but also provides hemostasis, reduces the risk of infection and gives a more successful cosmetic result. If the wound is to be left to secondary healing (self-closing without suturing), hemostasis must be achieved first. For this, direct pressure application, absorbable hemostatic Gelfoam, aluminum chloride hexahydrate, ferric subsulfate (monsel solution) can be applied.

6) After suturing, pure vaseline or antibiotic ointment is applied to the wound, covered with gauze and taped. If it is to be left to secondary healing, after hemostasis is achieved, antibiotic ointment is applied and covered with gauze and taped.

7) The piece taken is placed in formol solution for dermatopathological examination.

C) Postoperative Evaluation

1) 24 or 48 hours after the operation, the operation area is opened and washed with isotonic.

2) After washing, a simple dressing is applied by applying antibiotic ointment or pure vaseline.

3) Daily dressing is done until the stitches are removed. When the secondary healing is left, dressings are continued until the defect is closed.

4) The removal time of the sutures is 5-7 days for the face, 14 days for the trunk and extremities. After the sutures are removed, the wound lips can be supported for a while with tissue tapes (Steri-strips).

Side Effects and Complications

It can be listed as bleeding, infection, vascular and nerve damage, opening of sutures, bad scar development, keloid, hypertrophic scar development, pigmentation disorder.

Punch Biopsy

“Punch” biopsy is the process of taking a full-thickness cylindrical tissue sample from the lesional skin for biopsy.

Punch biopsy is an easy and practical method that is frequently used for the diagnosis of skin lesions.

Its advantage is that it provides full-thickness (from the epidermis to the subcutis) skin tissue, heals quickly and provides a very good cosmetic result (when closed with sutures).

The downside is that it is limited in size and depth. It is not suitable in cases where a large or deep biopsy is required, in indications and in some localizations (eyelids, ears, hands, feet, fingers and toes, extremities and especially localizations where important anatomical structures are superficial).

Shave Excision

It is a simple, fast and effective method that can be used for the diagnosis or treatment of papular lesions of epidermal or dermal origin.

Shave excision, which is used in seborrheic keratosis, pyogenic granuloma, polyp and many benign skin tumors, is a very simple, easy and effective method.

Excisional Biopsy

It is a method applied to reduce the number of procedures in the diagnosis and treatment of relatively small lesions. It is especially preferred in pigmented lesions suspected of malignant melanoma.

With excisional biopsy, it is possible to completely remove subcutaneous adipose tissue, fascia, deep-seated lesions located in muscle and superficial lesions. In this way, dermatopathological examination of the entire lesion can be performed. In this respect, it is very important to remove the entire lesion, especially in pigmented lesions with suspected melanoma. Again, some benign and malignant tumors have also been treated at the same time, and the number of procedures is decreasing.

Incisional Biopsy

Incisional biopsy is the surgical removal of a sufficient part of the skin lesion for diagnostic purposes.

In incisional biopsy, which is one of the most common surgical procedures in dermatology, a part of the lesion is taken, unlike excisional biopsy. In order to obtain a successful result, a piece of depth including subcutaneous tissue should be taken from the most suitable region (usually the most active region or the most typical region). Depth can also be adjusted according to the pre-diagnosis and characteristics of the lesion.