Choosing the Right Technique
The three main techniques used for the biopsy and/or removal of skin lesions are:
Other, more specific skin techniques, such as sebaceous cyst removal and z-plasty, are not covered in this unit. However, you may use the shared principles and techniques presented in this unit as a basis for understanding these approaches.
The choice between surgical techniques depends on the characteristics of the skin lesion in terms of size, location, and malignancy potential.
Size
The size of the skin lesion as well as its shape will help determine which skin surgery technique is appropriate. Lesions with smooth borders and less than 4mm in diameter can be readily removed with punch biopsy. If the lesion has irregular borders or is greater than 4mm in diameter shave or elliptical excision is the better choice.
In this image: The size of the lesion is being determined.
Location
Areas of the body where cosmetic result is important, such as the face and hands, are best biopsied with shave or elliptical excision.
In this image: The location of the lesion will help you determine which technique is best.
Malignancy Potential
Any skin lesion that may be malignant should be removed using a technique that will insure a full skin thickness depth and adequate margins. Both punch biopsy and elliptical excisions can be adequate to accomplish these requirements.