SKIN BIOPSY TECHNIQUES FOR THE INTERNIST

OBJECTIVE: To review three commonly performed skin biopsy procedures: shave, punch, and excision, DATA SOURCES: English-language articles id entified through a MEDLINE search (1966-1997] using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cro ss-references. STUDY SELECTION Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care, DATA EXTRACTION: Information was manually ex tracted from all selected articles and texts: emphasis was placed on i nformation relevant to internal medicine physicians who want to learn skin biopsy techniques, DATA SYNTHESIS: Shave biopsies require the lea st experience and time but are limited to superficial, nonpigmented le sions. Punch biopsies are simple to perform, have few complications, a nd if small, can heal without suturing. Closing the wound with unbraid ed nylon on a C-17 needle will enhance the cosmetic result but require s more expertise and time, Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, an d can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources, Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thi ck skin or a P-3 needle on the face, All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis. CONCLUSIONS: Skin biopsies ate an essential technique in th e management of skin diseases and can enhance the dermatologic care re ndered by internists.