Instruments for simple biopsies are found in Appendix G and can be ordered through local surgical supply houses.
A suggested anesthesia tray that can be used for this procedure is listed in Appendix F.
Skin preparation recommendations are shown in Appendix E.
Lesions amenable to shave excisional technique include acrochordons (i.e., skin tags), angiomas, fibromas, basal cell carcinomas (i.e., well-defined, small, primary and not recurrent, and in low-risk sites), dermatofibromas, keratoacanthomas, cutaneous horns, molluscum contagiosum, nonpigmented nevi (e.g., intradermal nevi), papillomas, warts, syringomas, venous lakes, cherry angiomas, stucco keratoses, seborrheic keratoses, actinic keratoses, rhinophymas, sebaceous hyperplasia, porokeratosis, neurofibromas, and dermatosis papulosa nigra.
Skin appendage lesions (e.g., cylindromas, epidermoid cysts—should be full thickness)
Subcutaneous lesions (pathology often missed by shave technique)
Epidermal nevi (removal requires full-thickness excision)
Infection at the site (relative)
Severe bleeding disorders (relative)
Patients on warfarin or clopidogrel (relative)
PEARL: Mask, gown, and sterile gloves are generally not necessary.
PITFALL: Unintentional penetration into the fat (i.e., yellow fat in the base of the wound) should prompt transforming the biopsy site into a sterile surgical wound. The wound should have the edges incised vertically, and the wound should be closed with sutures.
PEARL: Lesion removal can sometimes be facilitated by elevating and squeezing the surrounding skin.
PITFALL: The large, exposed, cutting surface of the razor blade and the hand tension required to maintain curvature of the blade provide great potential for injury. Some surgeons no longer advocate use of razor blades for shave biopsy because of this potential for injury.
PITFALL: The scissors must be flush with the skin surface to prevent leaving a residual stump, but no extra skin should be included within the scissor blades to prevent unintentional cutting of surrounding skin.
PITFALL: Novice physicians tend to scoop with the loop. The loop must be brought under the lesion horizontally, and the lesion must not be excessively elevated to prevent large scoop defects from this technique.
PITFALL: Ferric subsulfate can rarely produce permanent discoloration or “tattooing” of the skin. Consider using a 35% to 85% aluminum chloride solution on the faces of fair-skinned (light-complected) individuals to avoid this complication.
Hemostatic agents such as ferric subsulfate are available from surgical supply houses or the resources listed in Appendix G.
For practitioners wishing to perform shave biopsy with a razor blade, the disposable DermaBlade (Personna Medical, American Razor Company, Stauton, VA) enhances safety by allowing the operator to grasp the sure-grip teeth to the sides instead of directly handling the blade.
Radiosurgical generators; electrodes for dermatologic, gynecologic, plastic surgery, or ear, nose, and throat uses; smoke evacuators; and other accessories are available from
Ellman International, 1135 Railroad Avenue, Hewlett, NY 11557-2316 (phone: 800-835-2316; www.ellman.com)
Wallach Surgical Devices, 235 Edison Road, Orange, CT 06477 (phone: 203-799-2002; www.wallachsd.com).
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