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The removal of a tissue for accurate pathologic diagnosis is called biopsy. If the lesion is large and only a small part is to be removed, the surgery is called an incisional biopsy. Usually a small portion of normal adjacent skin is excised with the lump under question. When it is possible to completely remove the growth and obtain a margin of normal tissue around it, the procedure is termed an excisional biopsy. These are very useful procedures, not only for the diagnosis and treatment of blemishes and abnormal growths of the skin, but also for lumps beneath the skin in accessible organs, such as the breast.

A breast biopsy can often be performed without general anesthesia or hospitalization when the surgical skills are present and the necessity for tissue diagnosis exists. More commonly, skin biopsies are used to determine the presence or absence of cancer and to excise unsightly or irritating growths that have developed in areas amenable to their removal.

On certain parts of the face, such as the alar portion of the nose, the lips, and ears it may be necessary to cover the removed skin with a graft . “Split thickness” skin grafts can utilize a very thin membrane of excised skin that matches in color and texture the area requiring the covering. Specialized plastic surgery procedures under local anesthesia can at times be used to enhance the cosmetic results of these operations.

The technique of a skin biopsy utilizes an elliptical incision with the ends pointed to permit easier closure. The incision is made perpendicular to the plane of the skin to avoid bevel edges that will increase scarring of produce puckering when the wound is closed. “Undermining” the edges with blunt dissection will enable the skin areas to come together without undue tension and permit suturing with the least likelihood of wound separation. When malignancy is suspected, the margins should be wide enough to prevent possible early penetration of them with abnormal cells, and thus prevent the necessity of a second operation. Appropriate spacing of sutures and their removal in as short a time as wound healing will allow will minimize scarring and improve the cosmetic result of these surgical procedures.

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