More often than not, a skin sample may appear to be abnormal with regards to the fact that the skin has changed color, shape, or appearance. The change in skin color, shape, or general appearance can be due to skin cancer, fungal infection, psoriasis or any other infection of the skin. To confirm the actual cause of such abnormality on the skin, dermatologists usually recommend a skin biopsy, which involves the removal of part of the skin for use in the histological examination or any other relevant tests.
The word biopsy is derived from Greek words ‘bios’ meaning ‘life’ and ‘opsis’ which means ‘sight’ (Weller, Hunter, & Dahl, 2008). In its basic form, a skin biopsy implies the removal of part of the skin for histopathology, immunofluorescence and at times for culturing of organisms (Weller, Hunter, & Dahl, 2008). Before the procedure, the medical practitioner carrying out the procedure should undertake a few steps. These steps involve; obtaining a written consent from the patient, administering an anesthetic to block the pain from the area where the biopsy is to be done, and last but not least, removing the lesion from the infected area (Weller, Hunter, & Dahl, 2008).. Afterwards the doctor should file report based on the results of the biopsy citing the Current Procedural Terminology (CPT) code, which according to American Medical Association is 11100-1 for skin biopsy. This should be done in accordance with the medical regulatory provisions.
Prior to 1870s, no diagnostic biopsy was done due to the health risks that were attached to the procedure. It was until 1879 that the first diagnostic biopsy was done by a Russian Pathologist called M. M. Rudnev (Sprava, 1994). Biopsies and related procedures were highly restricted and in most cases. the methods that were used instead of a biopsy were histological methods that were not particularly much effective in diagnostics of skin conditions. However, the 19th century has witnessed an increase in the number of biopsies being done together with the development of numerous techniques of biopsy. These revolutions have seen the improvement of skin conditions diagnosis and treatment.
A skin biopsy just like any other medical procedure should entail preparations- a practice that is pertinent for the procedure to be successful. It is of utmost importance that the doctor carrying out the biopsy has the appropriate equipment before embarking on the procedure. A skin biopsy kit might come in handy during this stage of preparation. The kit contains; a 3 or 4 mm punch needle, scalpel, scissors, forceps, needle driver, alcohol wipes, fenestrated drape, betadine swab sticks, and gauze sponges. In addition, the kit can contain gloves (sterilized), specimen container with formalin. Most importantly, unbraided nylon, the kit should have an anesthetic. The most common anesthetic used by dermatologists is Lidocaine 1 or 2%. The effectiveness of this anesthetic can be enhanced with the aid of adrenaline that causes vasoconstriction of the biopsy area hence lowering the clearance of the anesthetic and hence prolonging the effect of the anesthetic (Weller, Hunter, & Dahl, 2008).
There are several types of skin biopsies namely; shave biopsy, punch biopsy, incisional biopsy, and excisional biopsy among other types (Sehgal, 2006). Of the above listed biopsy methods, the most common ones are the punch biopsy and the shave biopsy. The punch biopsy employs the use of a specially designed injection tool which is injected intradermally into the skin hence enabling the doctor to see the inside if the skin. Punch biopsies are preferred for checking inflammatory lesions like tuberculosis and leprosy (Sehgal, 2006). One main advantage of the punch is that the procedure is easy to master and has limited chances of leading to excessive bleeding and scarring.
Shave biopsy is yet another biopsy method that can be used to obtain sutures for use in histopathology (Sehgal, 2006). Shave biopsy enables harvesting the surface infected layer of the skin. The procedure is relatively easy and provides exceptional cosmetic results. The method, however, does not provide information about the parts of the skin below the lesion. Because this method removes lesion only from the surface of the skin, it cannot be used to harvest information about inflammatory conditions.
There are given times when the skin might be infected with diseases like malignant melanoma. This calls for the use of another method of skin biopsy called the excisional biopsy. Using this method, the practitioner can obtain larger samples that would not have been otherwise obtained using a different method, for instance punch biopsy. Incisional biopsy, on the other hand, involves making a deep incision into the skin using a needle (Sehgal, 2006). This procedure is tremendously useful in treating deep fungal infection.
Despite the effectiveness of skin biopsy, there are complications that may develop following such a procedure. The first risk being wound infection (Sehgal, 2006). Though uncommon, the wound after the incision can be infected with Candida or staphylococcus in susceptible individuals. Such infections can make the wound emit discharges, which might be unpleasant to the eye. Hemorrhage can also occur in response to the biopsy and can lead to excessive loss of blood (Sehgal, 2006). However, no hemorrhage resulting from a biopsy has been reported to lead exsanguinations or desanguination. Further, the use of blunt blades during the biopsy will result in undesirable result in that the biopsy sample may be damaged together with uneven appearance of briding nylon during debriding. Again, while punching, there stands a risk of damaging the internal blood vessels and the underlying structures (Sehgal, 2006). Another serious complication that can occasionally occur is a reaction to the antibiotics by patients leading to reddening and itching of the skin portion where the antibiotic was applied.
Before a decision to carry out a biopsy is arrived at between the doctor and the patient, there must be visible cues that suggest that a particular skin condition needs a biopsy for the condition to be reversed. Whenever a skin sample appears dark in color converse to the rest of the complection body, the most probable prognosis infection of the skin would be melanoma (Egan, 2005). This is a malignant condition of the skin whereby melanocytes absorb ultraviolet radiations, which interferes with the DNA of these cells making to reproduce uncontrollably and hence leading to cancer of the skin. Melanoma lesions start as small-pigmented patches on the skin, which increase in size and color, change over time. The lesion become itchy and darkens even further. Melanoma has the ability to spread ultra fast on the skin, especially over the surfaces of the skin constantly exposed to sunlight (Egan, 2005). Another most likely cause of a lesion of on the skin is the second type of cancer called the Carcinoma (Egan, 2005). Though not as fatal as melanoma, this form of cancer can cause unbearable pain to the victim. Furthermore, prognosis does not need to be necessarily accurate since it is just a prediction and not the actual diagnosis. Prognosis is based on the prevailing statistics of a certain disease, and is meant to give the patient and family members, an overview of what to expect.
The actual procedure of a skin biopsy is not painful. The painful bit of the biopsy is waiting for the results that take almost a week to come out. The agony is associated to the fear of the results indicating one is suffering from cancer, particularly melanoma. The results could also show that one is infected with other diseases like eczema. This implies that the procedure is not only used as a tool for detecting cancer alone but can be used to identify other infection of the skin including skin rashes.
Egan, T. (2006). Skin Cancer: Current And Emerging Trends in Detection And Treatment. New York, NY: The Rosen Publishing Group, Inc.
Sprava, L. (1994). Biopsy: its history, current and future outlook [Abstract]. National Center of Biomedical Information. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/7975522
Sehgal, V. N. (2006). Dermatologic Surgery Made Easy. New Delhi: Jaypee Brothers Publishers.
Weller, R. P. J. B., Hunter, A. A., & Dahl, M. V. (2008). Clinical Dermatology. Massachusetts: Blackwell Publishing.