Chapter 3 Excisional Biopsy
Common indication
Excisional biopsies are most often performed using an elliptical excision around a skin lesion, followed by a full-depth removal of the lesion with a surrounding margin of normal skin (Figure 3-1).
Equipment
The minimum equipment needed for an excisional biopsy includes a needle driver, iris scissors, Adson’s forceps, a No. 15 blade scalpel, and a curved hemostat (Figure 3-2). A variety of sutures are used for closure, depending on the location of the biopsy and the wound tension. Generally, a 4-O nylon suture will provide adequate wound closure for most areas. If a subcuticular closure is planned, use a 3-O or 4-O absorbable braided suture.
Key steps
1. Anesthesia: Cleanse the skin with alcohol, and inject local anesthetic in a field block around the planned ellipse of the incision. Ensure that the local block is wide enough for the incision and for undermining the skin edges (Figure 3-3). After the block is placed, cleanse the skin with Betadine then drape the area to create a sterile field.
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