Section One
Dermatological Procedures
Chapter
Punch Biopsy
1
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 exami-
nation. 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
1
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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.
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● 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.
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Figure 1.3 Cut with scissors.
● 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.
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Dermatological Procedures
Chapter
Punch Biopsy
1
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 exami-
nation. 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
1
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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.
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● 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.
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Figure 1.3 Cut with scissors.
● 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.
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