The lesion is marked, and a local anaesthetic is injected around the lesion.
Antiseptic is applied, and the doctor removes the lesion surgically.
With a punch biopsy, a sample of the lesion only is removed, to find out what exactly the lesion is, to guide what further treatment is necessary and appropriate.
A tool is used to take a circular sample of 3 to 8 mm diameter, which is sent to the lab for a pathologist to examine and provide a report.
The report is sent to the doctor about 3 weeks after the biopsy (Jan 2022).
The biopsy site is usually sutured closed using 1-3 nylon sutures. The wound needs to be kept dry for 24 hours and dressed daily until the sutures are removed.
You will need to have an appointment with the practice nurse one week following the biopsy to have the sutures removed. We do not use dissolving sutures for punch biopsies.
An excision, or excisional biopsy, is a larger operation where the entire lesion is removed by cutting around the lesion and taking an appropriate margin of normal-appearing tissue as well.
This is ‘cutting out’ a lesion, and is used when the lesion is suspected to be melanoma or to remove a lesion that is known to be skin cancer.
The length of a wound is usually about 5 times the diameter of the lesion, in order to make an ellipse that closes with as little tension as possible into a straight line.
Usually, the wound is closed with a layer of dissolving sutures underneath the skin (“like the foundation of a house”) and a layer of non-dissolving sutures on the surface of the skin to hold the wound edges carefully together so that the wound heals well.
The surface sutures need to be removed by the practice nurse usually 7, sometimes 10 days, following the procedure.
Wound care is the same as for punch biopsies, except larger. There is a higher risk of wound infections (2%) with excisions, and if you have diabetes or other conditions where you may be susceptible to infections, or if the operation is on the lower leg or foot, you may be prescribed a dose of antibiotics to take one hour prior to the operation to reduce the risk of infection.
Curettage is a type of procedure where certain non-cancerous lesions which are uncomfortable or unsightly are gently shaved off using a special tool. This results in a superficial graze-like wound that needs to be dressed daily for a week or so.
The different procedures are used for different purposes and the doctor will advise which type of procedure is appropriate for your skin lesion.