What is a skin biopsy?

Skin or Punch biopsy is an investigational procedure to obtain skin specimens or to remove the lesion for laboratory analysis. This procedure is done on an outpatient basis and is usually done under local anesthesia. The skin specimen is obtained using a punch or steel blade and the wound is closed with stitches and a dressing will be applied. No stitches will be used when a shave biopsy is done.

Why is there a need for skin biopsy?

The advantage of skin biopsy is that the dermatologist can now treat the skin problem with a definitive diagnosis after the laboratory analysis. The alternative of not doing the skin biopsy is to start treatment based on clinical diagnosis.

How do dermatologists decide when to do a skin biopsy?

A lot of skin diseases are treated on the basis of clinical diagnosis e.g. eczema, psoriasis and urticaria. However, certain skin diseases mandate a skin biopsy because the treatment plan hinges on an accurate and definitive diagnosis, e.g.:

• Skin cancer concern or rapidly enlarging growth
• Blistering skin diseases
• Special situation e.g. inflammation of the fat (panniculitis), inflammation of the blood vessels (vasculitis), Kaposi sarcoma and etc

Sometimes, dermatologists can be stumped and are not sure of the clinical diagnosis. A skin biopsy will be a useful test to provide additional information.

What should I be concerned about?

Generally, the biopsy procedure is safe and without any side effects. However, as with any surgical procedure there are rare but possible complications as follow:

• Abnormal healing of the wound
  In some people, healing of the wound may be abnormal and the wound can be thickened and become keloid. Discuss with Dr Wong if you have any concern
• Abnormal analysis
  It may turn out to be different and not the initial suspected problem. More tests with “immunostaining” may need to be done. The additional immunostaining is to help the laboratory to study the specimen/lesion better.

What happens after the skin biopsy?

There is usually minimal postoperative pain, discomfort or downtime and the patient is fit to go back to work. Wound review and dressing change will be arranged 1-2 days postoperatively and suture removal is generally 7-14 days later.

The test report is usually available 5-6 days later and Dr Wong will discuss the result of the test report with you and plan for further treatment during your follow-up visit to the clinic.

Concern about scarring

Dr Wong always tells his patients the following:

• If we are dealing with cancers, scar is our secondary concern. The primary objective is to remove all the cancerous cells and we would try to obtain as good a scar as the situation permits
• We would avoid skin biopsy if we could proceed with treatment based on clinical diagnosis alone. Otherwise, a skin biopsy with a little scar is unavoidable.
• Dr Wong is trained in dermatology surgery and he has done biopsy on a weekly basis for 30 years. Rest assured, you are in good hands with an experienced dermatologist. He will do his best to optimise the wound healing to minimize the scar.

Cost

• A punch biopsy starts from $350 onwards
• Assurance Skin clinic follow the benchmark surgical fees set by Ministry of Health in 2019 for other types of skin biopsy / surgery