From the Guidelines
Before a skin biopsy under local anesthesia, minimal medical workup is typically required as it's a minor procedure. Patients should inform their doctor about all medications they're taking, particularly blood thinners like warfarin, clopidogrel, or aspirin, as these may increase bleeding risk 1. The doctor should be made aware of any allergies, especially to local anesthetics like lidocaine. Patients with a history of abnormal scarring or keloids should mention this. There's usually no need to fast before the procedure. Blood tests are generally not required unless there are specific concerns about bleeding disorders or infection risk. Patients should clean the biopsy area before arriving but avoid applying lotions or creams. After the procedure, patients should follow wound care instructions, which typically include keeping the site clean and dry for 24 hours, then gentle cleaning and application of antibiotic ointment. The minimal workup reflects the low-risk nature of skin biopsies, which are outpatient procedures with few complications when performed by trained professionals.
Key Considerations
- Medication review: Patients should disclose all medications, especially blood thinners, to their doctor 1.
- Allergy assessment: Patients should inform their doctor about any allergies, particularly to local anesthetics like lidocaine.
- Medical history: Patients with a history of abnormal scarring or keloids should mention this to their doctor.
- Pre-procedure preparation: Patients should clean the biopsy area before arriving but avoid applying lotions or creams.
- Post-procedure care: Patients should follow wound care instructions, which typically include keeping the site clean and dry for 24 hours, then gentle cleaning and application of antibiotic ointment.
Evidence-Based Recommendations
The American Academy of Dermatology guidelines for the use of local anesthesia in office-based dermatologic surgery provide recommendations for the use of topical anesthesia in dermatologic surgery, including skin biopsy 1. The guidelines suggest that topical agents are recommended as a first-line method of anesthesia for nonablative laser treatments and can be used for performing office-based procedures, such as skin biopsy, small excisions, and filler and botulinum toxin injections. However, the most recent and highest quality study on this topic is not available, and the provided evidence is mostly related to liver biopsy and not directly applicable to skin biopsy. Therefore, the recommendations are based on general medical knowledge and the provided example answer.
From the Research
Pre-Procedure Medical Workup for Skin Biopsy under Local Anesthesia
The required pre-procedure medical workup for a patient undergoing a skin biopsy under local anesthesia includes:
- Checking the international normalization ratio (INR) for patients on warfarin, preferably within 24 hours before the procedure, to minimize the risk of bleeding complications 2
- Reviewing the patient's medical history and current medications to identify potential risks and interactions
- Assessing the patient's overall health and suitability for the procedure under local anesthesia
Specific Considerations
- For patients on warfarin, a preoperative INR of < 3.5 is considered safe for cutaneous surgical procedures, including skin biopsies 2
- The choice of lesion to be sampled and the biopsy technique used should be guided by the suspected clinical diagnosis and the morphology of the lesion 3, 4, 5
- Proper administration of local anesthesia is crucial to ensure a painless procedure 4
Additional Factors
- The patient's stress levels and anxiety should be considered, as facial skin cancer surgery under local anesthesia can cause increased stress in some patients 6
- The benefits of local anesthesia, including decreased health care costs and minimized operative time, should be weighed against potential disadvantages 6