Summary Advanced Practice Nursing Procedures

Advanced Practice Nursing Procedures Dermatological Procedures Chapter 1 Punch Biopsy Margaret R. Colyar CPT Code 21550 Biopsy of soft tissue of neck or thorax 21920 Biopsy of soft 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