Skin biopsy – summary
| When to do it | When tissue examination is necessary for the diagnosis of a skin lesion or condition |
|---|---|
| Anaesthesia | Local, injected into the skin at the sampling site |
| Duration | About 20 minutes, including preparation |
| Pain | During the procedure nothing is felt, thanks to the anaesthesia |
| Results | Usually within 7 to 10 days; longer when additional analyses are required |
| Procedure performed by | Consultant Dermatologist |
What is a skin biopsy?
A skin biopsy is the taking of a small sample of skin, and histopathological analysis is the examination of it under a microscope – these are two steps of the same diagnostic path, not synonyms. The analysis shows what the tissue looks like at the cellular level and helps to clarify the cause of the lesion. A biopsy is not only performed when a tumour is suspected. It is also used in the diagnosis of inflammatory, autoimmune and infectious skin diseases, for rashes of unclear cause and for lesions that do not respond to treatment. The decision to perform a biopsy is made after dermatologist's appointment, when the clinical finding is not sufficient for a reliable diagnosis.
When is a skin biopsy recommended?
Individual skin lesions
A biopsy is recommended for lesions whose appearance does not allow for a reliable assessment: pigmented lesions that are changing, sores or crusts that do not heal, and growths of unclear origin, actinic keratoses and other lesions where a tumour needs to be ruled out. In the case of pigmented lesions, the decision is usually preceded by dermoscopic examination.
Inflammatory and other skin diseases
A biopsy also helps when a rash, redness, flaking or blisters have no clear cause, when autoimmune skin conditions are suspected, in the case of certain infections, and when it is necessary to confirm a diagnosis before long-term treatment or to monitor the course of a disease.
A recommendation for a biopsy in itself does not mean that the doctor suspects cancer. A biopsy provides additional information about changes in the tissue, and the dermatologist links this with the appearance of the skin, symptoms and other findings in order to determine a diagnosis and appropriate treatment plan.
Is a biopsy also performed on the scalp?
For certain scalp conditions and hair loss of unclear cause, a doctor may recommend taking a scalp skin sample. The decision is preceded by an examination and, where necessary, trichoscopy, which allows the scalp and hair roots to be viewed under magnification. Biopsy is not routinely necessary for every case of hair loss. It is considered when clinical findings and trichoscopy are insufficient for a reliable diagnosis or when a scarring scalp condition is suspected.
How to prepare for a biopsy?
Special preparation is usually not necessary. It is important to tell the doctor:
- which medicines and supplements do you take, and in particular blood thinners;
- do you have an allergy to local anaesthetics, disinfectants or plasters?;
- do you bruise or bleed easily;
- have you previously had problems with wound healing or prominent scars;
- are you pregnant or do you have any chronic illnesses?.
Bring earlier findings and the results of previous analyses, if you have them. Prescribed therapy should not be stopped independently; any changes will be decided by the doctor.
What types of biopsy do we perform?
The method of sampling is chosen according to the lesion and the purpose of the examination, and the sample size depends on what needs to be analysed.
| Technique | What is being taken | Stitches |
|---|---|---|
| Shave biopsy | Superficial layers of skin with changes, using a special thin blade | Not required |
| Punch biopsy | punch biopsy | Sometimes one or two stitches |
| Excisional biopsy | Excision of the lesion with a narrow margin of healthy skin, using a scalpel | Yes |
When only a part of a larger lesion is taken, it is referred to as an incisional biopsy; this can be done using a punch instrument or a scalpel. When it is necessary to remove the entire pigmented lesion for analysis, the doctor may recommend surgical removal of a mole, which is also an excision biopsy.
What does the skin biopsy procedure involve?
1. Assessment and consent
A dermatologist examines the lesion, explains why a biopsy is needed and which technique will be used. The patient signs the consent form for the procedure.
2. Preparation and anaesthesia
The site is disinfected and a local anaesthetic is injected. There is a brief stinging sensation until the skin goes numb, after which no pain is felt. The patient is awake throughout the procedure.
3. Taking a sample
The sample is taken using the chosen technique – shave, punch or excision – so that it is sufficient and representative for analysis.
4. Wound management
A small wound is left to heal on its own, with a protective dressing. If a larger sample has been taken, the wound is closed with stitches.
5. Laboratory
The sample is sent to the laboratory, where a pathologist processes it and examines it under a microscope.
6. Findings and plan
The dermatologist interprets the test result in conjunction with the clinical presentation and proposes the further course of action: treatment, monitoring, additional analyses or the removal of the remaining lesion.
When do the skin biopsy results arrive and who interprets them?
At the Imedic Polyclinic, the expected turnaround time for a histopathological report is usually 7 to 10 days. Additional staining, immunohistochemical analysis or consultation with another pathologist may prolong the process, on rare occasions up to a month. The waiting time itself does not indicate what the result will be. The sample is analysed by a pathologist, and the report is interpreted by a dermatologist along with the clinical findings and previous tests. The histopathological report describes changes in the removed tissue, and if the lesion has been completely removed, it may also include an assessment of its margins.
The result is explained at the follow-up appointment, where further steps are agreed upon: therapy, monitoring, additional tests or removal of the remaining lesion. Sometimes the finding is not sufficient on its own, so the doctor may recommend supplementary tests or a new sampling.
Recovery and wound care
Following the biopsy, you will receive instructions tailored to the site and method of sampling. These state when you may remove or change the dressing, wash the area, and resume normal activities. The guidelines below describe the usual course.
- the first two days – the treatment site must not get wet while the dressing is on it;
- showering and washing – after that, the wound is rinsed with lukewarm water and gently dried, and then, according to the doctor's instructions, a thin layer of a healing preparation is applied and a new dressing is put on;
- stitches – if present, they are removed after 5 to 14 days, depending on the location and the rate of healing; skin on the legs and feet heals more slowly;
- physical activity – exertion, swimming pools and saunas are to be avoided until the wound has healed, and a doctor will assess when it is safe to return to training based on the biopsy site and the condition of the wound;
- sun – the overgrown region is protected from the sun for several months, so that the scar does not darken.
The surgery should be contacted if bleeding does not stop after pressure, if increased redness, swelling, heat, pus or an elevated temperature appear, or if the wound comes apart.
Skin biopsy cost
The price of a skin biopsy with histopathological analysis is stated in dermatology price list. The final scope of the procedure depends on the type and size of the lesion and is determined after the examination.
Frequently asked questions about skin biopsy
Why has my dermatologist recommended a biopsy?
A biopsy is recommended when a clinical examination is not sufficient to reliably explain a lesion. The sample is used in the diagnosis of inflammatory, autoimmune and infectious skin diseases, for lesions that do not respond to treatment, and also for individual lesions where a tumour needs to be confirmed or ruled out. The recommendation for a biopsy alone does not determine the diagnosis.
How long does a skin biopsy take and does it hurt?
The procedure takes about 20 minutes, including preparation. There is a brief stinging sensation when the local anaesthetic is given, after which the procedure is painless. Once the anaesthesia wears off, the area may be tender for a few days.
Is the entire lesion removed?
It depends on the technique. With an excision biopsy, the entire lesion is removed, whereas with shave, punch and incisional biopsies, usually only a part of it or the surface layer is removed, as much as is necessary for analysis. The doctor chooses the technique based on the lesion and the purpose of the investigation.
Are stitches required?
The need for stitches depends on the technique, size and site of the biopsy. With a shave biopsy, stitches are usually not required; following a punch biopsy, one or two stitches are sometimes placed; and after an excision biopsy, the wound is most often closed with stitches. If non-dissolvable stitches are used, the doctor will determine when they are to be removed.
Will there be a scar left?
A scar or skin discolouration may remain at the biopsy site. The appearance depends on the technique, size and location of the sample, as well as individual healing. Sun protection and care according to the doctor's instructions help make the mark as unnoticeable as possible. If you have previously had prominent or raised scars, tell your doctor before the procedure.
When is it possible to return to work and training?
Most patients return to activities that do not involve physical exertion on the same or the following day. Return to training is determined by the biopsy site, skin strain, and the condition of the wound. Removal of stitches does not automatically mean that all physical activities are permitted.
Why is the result sometimes delayed?
When the pathologist determines that additional staining, immunohistochemical analyses, or a consultation with another pathologist are required, preparing the report takes longer. This does not mean that the result is abnormal, but rather that more information is needed for a reliable diagnosis.
Are there any risks?
A skin biopsy is a routine procedure, but like any procedure it can have complications: mild soreness, bleeding during and for a few hours after the procedure, and more rarely infection, a haematoma or a reaction to the stitches, as well as a scar. Therefore, it is important to follow the wound care instructions and to contact a doctor if signs of infection appear.
What is included in the service?
The price in the price list refers to a biopsy with histopathological analysis. Information on what exactly the term covers and how to book a follow-up appointment for the interpretation of results is provided when booking.
Schedule a skin biopsy in Belgrade
The Imedic Polyclinic is located at Kneza Miloša 23 street, 2nd floor, Belgrade. Opening hours: Monday–Sunday, 9:00–21:00.
Appointments are made by phone: 064 237 0707. If you contact us from abroad, we are also available via Viber and WhatsApp on the same number.
Author: Dr Ivica Jeremić
Doctor of Medical Sciences (Molecular Medicine and Immunology), subspecialist in rheumatology, dermatology resident.
Updated:
Expert sources
- Skin Biopsy. StatPearls, NCBI Bookshelf.
- Excisional Biopsy. StatPearls, NCBI Bookshelf.
- DermNet Skin biopsy.
