What are best practices for a punch biopsy in the treatment of benign skin lesions?

Updated: Jan 30, 2020
  • Author: Ginard I Henry, MD; Chief Editor: Gregory Gary Caputy, MD, PhD, FICS  more...
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A punch biopsy is usually performed with a specialized trephine (ie, biopsy punch) that is a device with a knife conformed into a complete circle that is slightly tapered at the end. After local anesthesia is administered, the trephine is twisted in a back-and-forth motion and pushed down through the skin to incise the entire thickness of the dermis. The circular segment of skin is removed; optimally, a small amount of subcutaneous fat is included.

Biopsy punches usually have a diameter that ranges from 2-12 mm. Biopsy devices 2-5 mm in size are most common, and the resultant wounds often do not require suture closure. The round shape facilitates quick wound contracture and spontaneous closure. A biopsy diameter greater than 5 mm usually needs a simple suture to adequately close the wound. When a biopsy punch is not available, a similar amount of tissue may be incised freehand with a scalpel.

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