"What spirit is so empty and blind, that it cannot recognize the fact that the foot is more noble than the shoe, and skin more beautiful than the garment with which it is clothed?" Michelangelo

Skin Procedure Checklist: Punch biopsy

1. Is the lesion amenable to a punch biopsy?
2. Are there vital structures (such as the eye) nearby the punch biopsy site? If so, is there a plan in place to avoid them?
3. Has the patient verified the exact lesion to be biopsied or removed? Use of a mirror may be needed.
4. Has the history been updated and reviewed, esp. regarding recent medications or substances that may interfere with hemostasis? See Common Elements of Interventional Pathologists' Procedures
5. Are there any contraindications, such as the anatomic location of the punch biopsy site being near superficial nerves (Facial, Accessory) or arteries (brachial, radial or ulnar arteries) ?
6. Has informed consent from the patient been personally obtained by the interventional pathologist who explains to the patient how the procedure will be performed, step-by-step, as well as possible complications such as persistent divot or indentation, persistent erythema, hypopigmentation, regrowth of incompletely punched lesion, infection, bleeding, granulation tissue, hypertrophic scar, keloid, or excessive protrusion of skin at the edges of the scar (“dog ears”)?
7. Have comprehensive written pre- and post-punch biopsy instructions been given to the patient ?
8. Has followup with the patient been scheduled? If so, when? where? with whom?
9. Is the patient contact information, including telephone numbers and email address, current and correct?

Indications for a punch biopsy

To diagnose:
Inflammatory skin diseases
Granulomas: sarcoidosis, mycobacteria, fungus, etc
Erythema nodosum
Kaposi sarcoma
Basal cell carcinoma
Squamous cell carcinoma
Cutaneous T-cell lymphoma

To remove:
Neurofibroma and neurofibroma
Small benign melanocytic nevi
Sebaceous hyperplasia
Pyogenic granuloma
Skin tag

globe image


homepage button

Byron L. Barksdale, M.D.

Copyright©, including the "I" chart, 1999-2017.  Internet Physician, Inc. All rights reserved.