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This chapter focuses on the most common procedures in dermatology that include biopsy techniques as well as surgical procedures for removal of benign and malignant tumors. Videos of these procedures on pig's feet and in a clinical setting can be found at The reader should seek hands-on supervised training to supplement the content in this section.



A skin biopsy is done to gather more information than is available from the patient's history and physical examination. This information can be used to establish or confirm a diagnosis. Often clinicians hesitate to perform a biopsy. There may be concerns about the cosmetic impact on the patient, the trauma associated with the procedure, or the technical aspects involved. Some disease processes are prone to sampling error and may require multiple skin biopsies for diagnosis. This is classically the case with cutaneous T-cell lymphoma or diseases with lesions of various stages or morphology.

Types of Biopsy Techniques

It is important to select the appropriate site, lesion, and technique for a biopsy. This often means focusing on the location of the suspected pathologic process, for example, the epidermis, the dermal epidermal junction, deeper dermal structures, or subcutaneous dermal fat or muscle. The likely location of the pathology will determine if a shave, punch, or an excisional biopsy is most appropriate (Table 7-1).1,2 A biopsy should not be done on lesions that are excoriated or eroded.

Table 7-1.Lesion, site, and biopsy selection for skin disorders.

  • Shave biopsy: This is ...

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