Dermatological Procedures
Chapter 1
Punch Biopsy
Margaret R. Colyar
CPT Code
21550 Biopsy of soft tissue of neck or thorax
21920 Biopsy of soft
... [Show More] tissue of back or flank, superficial
23066 Biopsy of soft tissue of shoulder, superficial
24065 Biopsy of upper arm and elbow area
23066 Biopsy of soft tissue of forearm or wrist, superficial
27040 Biopsy of soft tissue of pelvis and hip area
27323 Biopsy of soft tissue of pelvis and hip area
27613 Biopsy of soft tissue of leg and ankle area
11100 Skin lesion—Depends on the site, technique, and if benign
or malignant lesions
Biopsy is the removal of a small piece of tissue from the skin for microscopic examination.
Partial or full thickness of skin over the lesion is removed for evaluation.
OVERVIEW
Punch biopsy is used for full and partial dermal lesions such as
● Basal cell carcinoma
● Squamous cell carcinoma
● Actinic keratoses
● Seborrheic keratoses
● Lentigo (freckles)
● Lipomas
● Melanomas
● Nevi
● Warts—verruca vulgaris
RATIONALE
● To confirm etiology of lesion for treatment
● To establish or confirm a diagnosis for treatment and/or intervention
2 Section One | Dermatological Procedures
INDICATIONS
● Partial- or full-dermal-thickness lesion not on the face, eye, lip, or penis
CONTRAINDICATIONS
● Lesion on eyelid, lip, or penis, REFER to a physician.
● Infection at the site of the biopsy
● Bleeding disorder
● Lesions that are deep or on the face, REFER to a physician.
◗ Informed consent required
PROCEDURE
Punch Biopsy
Equipment
● Antiseptic skin cleanser
● Drape—sterile
● Gloves—sterile
● Disposable biopsy punch (Fig. 1.1)
● Pickups—sterile
● Scissors—sharp for the fine tissue—sterile
● 3-mL syringe
● 27- to 30-gauge, ½-inch needle
● 1% lidocaine
● Container with 10% formalin
● 4 × 4 gauze
Figure 1.1 Disposable biopsy
punches.
Chapter 1 | Punch Biopsy 3
● Nonstick dressing (Adaptic or Telfa)
● Kling
● Tape
● Steri-Strips (if biopsy will be greater than 4 mm) or one suture
Procedure
● Position the client so that the area to be biopsied is easily accessible.
● Cleanse the skin with antiseptic skin cleanser.
● Put on gloves.
● Drape the area to be biopsied.
● Anesthetize with 1% lidocaine.
● With the thumb and index finger, spread the skin to apply tension opposite
natural skin tension lines. This allows a more elliptical-shaped wound for easy
closure.
● Apply biopsy punch to skin, rotate per manufacturer’s directions, and remove
the punch (Fig. 1.2).
● With pickups, pull up loosened skin.
● Cut with scissors, and place tissue in tissue container of 10% formalin
(Fig. 1.3).
● If less than 2 to 3 mm, apply nonstick dressing and pressure dressing.
● If greater than 4 mm, apply Steri-Strips and cover with 4 × 4 gauze.
● Apply Kling and secure with tape.
Client Instructions
● Keep dressing clean, dry, and in place for 48 hours to decrease the chance of
bleeding and oozing.
● Avoid touching or contaminating the area biopsied.
● To prevent the chance of infection, take cephalexin (Keflex) 500 mg three times
per day or amoxicillin (Amoxil) 500 mg twice a day for 5 days.
Figure 1.2 Apply biopsy punch to skin and
rotate.
4 Section One | Dermatological Procedures
● Some redness, swelling, and heat are normal. Return to the office if symptoms
of infection occur, such as
● Yellow or green drainage
● Red streaks
● Pain
● Elevated temperature
● Take acetaminophen (Tylenol) or ibuprofen (Motrin) every 4 to 6 hours as
needed for pain.
BIBLIOGRAPHY
De Vries HJ, Zeegelaar JE, Middelkoop E, et al. Reduced wound contraction and scar
formation in punch biopsy wounds. Native collagen dermal substitutes. A clinical study.
Br J Dermatol. 1995;132(5):690–697.
Zuber TJ. Ingrown toenail removal. Am Fam Physician. 2002;65(12):2547–2550.
Figure 1.3 Cut with scissors.
Chapter 2 | Skin Biopsy 5
Chapter 2
Skin Biopsy
Margaret R. Colyar
CPT Code
11300–03 Shaving of epidermal or dermal lesion; single lesion—
trunk, arms, or legs
11305–08 Shaving of epidermal or dermal lesion; single lesion—
scalp, neck, hands, feet, or genitalia
11400–06 Excision benign lesions—trunk, arms, or legs
11420–26 Excision benign lesions—scalp, neck, hands, feet, or
genitalia
11600–06 Excision malignant lesions—trunk, arms, or legs
11620–26 Excision malignant lesions—scalp, neck, hands, feet, or
genitalia
Skin biopsy is the excision of a small piece of living tissue for microscopic examination.
The two major categories of skin biopsy are
● Partial dermal thickness—shave and curettage
● Full dermal thickness—punch and elliptical excision
HEALTH PROMOTION/PREVENTION
● Inspect the skin periodically for lesions.
● Note lesions that change size or color, are irregular, or are painful.
OPTIONS
● Method 1—Shave biopsy
● Use for elevated skin lesions such as
• Skin tags
• Benign nevi (interdermal)
• Epithelial tags
• Small basal cell carcinomas
• Condyloma acuminatum
• Cherry angiomas
• Actinic keratoses
• Seborrheic keratoses [Show Less]