What to do if a skin biopsy of a forehead recurring lesion using a Dermablade (dermatological blade) doesn't represent the whole lesion?

From the Guidelines

If a skin biopsy of a recurring forehead lesion using a Dermablade doesn't represent the whole lesion, a more comprehensive biopsy such as a punch biopsy or excisional biopsy is recommended to obtain a representative sample of the entire lesion. This approach is supported by the most recent guidelines, which emphasize the importance of thorough evaluation for accurate diagnosis and treatment planning 1.

Key Considerations

• Shave biopsies with a Dermablade are often superficial and may only sample the top layers of the skin, potentially missing deeper components of lesions that could be precancerous or cancerous.
• Recurring lesions particularly warrant thorough evaluation since persistence can indicate a more serious condition that requires complete assessment for proper diagnosis and treatment.
• The choice of biopsy technique should be guided by the location and size of the lesion, as well as the clinical suspicion of malignancy.

Recommended Biopsy Techniques

• Punch biopsy: allows for deeper tissue sampling and can capture the full architecture of the lesion.
• Excisional biopsy: includes the whole tumor with a clinical margin of normal skin and a cuff of fat, allowing for confirmation of the diagnosis and subsequent definitive treatment based on Breslow thickness 1.

Post-Biopsy Care

• Keep the site clean with gentle soap and water.
• Apply petroleum jelly and cover with a bandage for 24-48 hours.
• Local anesthesia (typically 1-2% lidocaine with epinephrine) may be suggested by the dermatologist before performing the procedure.

It is essential to consult with a dermatologist to determine the best course of action for a recurring forehead lesion that was not adequately sampled by a Dermablade biopsy, considering the potential risks and benefits of each biopsy technique and the importance of accurate diagnosis for guiding treatment decisions 1.

From the Research

Skin Biopsy of a Forehead Recurring Lesion

• If a skin biopsy of a forehead recurring lesion using a Dermablade does not represent the whole lesion, it may be necessary to consider alternative biopsy techniques to obtain a more representative sample.
• The choice of biopsy technique depends on the size of the lesion, suspected clinical diagnosis, and site of the lesion 2.
• Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens and can be used to excise or sample a variety of lesions, including pigmented nevi 3.
• Elliptical biopsy using a scalpel is reserved for larger lesions not amenable to shave or punch biopsies 4.
• It is essential to handle the specimen carefully to avoid crush artifact, which can affect the accuracy of the diagnosis 3.

Considerations for Biopsy Techniques

• Shave biopsy is suitable for small, raised, benign lesions, while punch biopsy and elliptical biopsy are more suitable for deeper or larger lesions 4.
• The tangential punch biopsy allows a dermatologist to obtain a full-thickness skin sample, and the post-biopsy wound heals by primary closure or second intention 5.
• Site selection is crucial when performing a skin biopsy, especially with diffuse eruptions, and the choice of technique should be thoughtful to improve the yield of the biopsy 6.

Potential Complications and Considerations

• Complications such as bleeding, infection, and scarring may occasionally be encountered while performing a biopsy, and practical steps can be taken to curtail these complications 2.
• The development of hypertrophic and keloid scars is a potential complication of skin biopsy, especially among patients with dark skin, and injection of triamcinolone or verapamil into a maturing scar can minimize this possibility 4.