From the Guidelines
A shave biopsy procedure note should document the removal of a skin lesion using a saucerize or scoop technique that may penetrate deep into the dermis, as recommended by the guidelines of care for the management of cutaneous squamous cell carcinoma 1. The procedure note should include patient identification, date, and indication for the procedure, as well as the location and appearance of the lesion, including size, color, and characteristics.
- The note should detail the skin preparation with antiseptic solution,
- local anesthesia administration (usually 1-2% lidocaine with epinephrine),
- and the shaving technique using a scalpel or razor blade to remove the lesion at the appropriate depth,
- as well as whether hemostasis was achieved (typically using aluminum chloride, electrocautery, or chemical cautery),
- how the wound was dressed (usually with antibiotic ointment and a bandage),
- and that the specimen was sent to pathology. The documentation should also include post-procedure instructions given to the patient, including wound care, signs of infection to monitor, and follow-up plans, as the selection of the specific biopsy technique is contingent on the clinical characteristics of the suspected tumor, including morphology, expected histologic subtype and depth, natural history, and anatomic location; patient‑specific factors, such as bleeding and wound healing diatheses; and patient preference and physician judgment 1. The goal of the shave biopsy is to provide adequate tissue for diagnosis while minimizing biopsy-associated discomfort, trauma, risk for wound infection or dehiscence, scar, or loss of function, particularly on the head, neck, and other vital, functional, sensory, or cosmetically sensitive sites 1.
From the Research
Shave Biopsy Procedure
- A shave biopsy is a procedure used to remove a skin lesion for diagnostic purposes 2, 3.
- There are two types of shave biopsies: tangential shave biopsy and saucerization shave biopsy 2.
- Tangential shave biopsy is superficial and best suited for small, raised, benign lesions 2.
- Saucerization shave biopsy is deeper and used for excisional biopsy of atypical nevi, squamous and basal cell carcinomas, and as initial biopsy for suspected melanoma 2.
Indications and Contraindications
- Shave biopsies are essential procedures for physicians who manage skin conditions, including possible malignancies 3.
- Indications for biopsy of suspected melanoma remain controversial, with sufficient tissue possibly obtained with saucerization biopsy or elliptical excisional biopsy 3.
- Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions 4.
Technique and Complications
- The procedure involves removing the lesion using a specialized tool, with the specimen then submitted for pathologic examination 4.
- Potential complications of skin biopsy include the development of hypertrophic and keloid scars, which are more common among patients with dark skin 2.
- Injection of triamcinolone or verapamil into a maturing scar can minimize the possibility of hypertrophic and keloid scars 2.
Comparison with Other Biopsy Techniques
- Shave biopsies are compared to punch biopsies, with punch biopsies yielding full-thickness samples and used for lesions that require dermal or subcutaneous tissue for diagnosis 3.
- Elliptical excisions are ideal for removing large or deep lesions but require the greatest amount of time, expertise, and office resources 4.
- Recent changes in reimbursement for shave and punch biopsies have led to small yet important changes in biopsy use patterns 5.