What is an excision biopsy?
An excision biopsy is a bedside procedure where your doctor uses a surgical blade to remove the entire skin lesion under the use of local anaesthesia.
- Allows removal of a lump, or skin lesion to aid making a diagnosis.
- By removing the skin lesion, inconveniences symptoms such as rubbing/friction, pain can be alleviated
What can an excision biopsy examine?
- Skin cancer **
What results can I expect?
The surgical site will heal eventually with a linear scar. Although careful surgical technique can minimize scarring, it is not possible to avoid scarring from the procedure.
How many sessions needed
Usually 1 session should suffice. Your doctor may advise you to return to clinic in 1-2 weeks time for follow up of the procedural site.
No fasting is required. You are advised to inform your doctor on your past medical histories and medication that you are taking.
Excision skin biopsy is performed under local anaesthesia. Your doctor will administer numbing injection to the surrounding of the skin lesion prior to surgical removal of the lesion. Patients may experience mild discomfort from the numbing injection, the procedure itself otherwise is painless. After procedure, you may feel mild discomfort, and you doctor usually discharge you with simple analgesia such as paracetamol or ibuprofen.
Excision skin biopsy allows the physician to remove the entire abnormal skin lesion together with the surrounding normal skin tissues. The wound is subsequently closed with sutures.
Excision biopsy procedure can be done in outpatient, surgical setting. The process takes approximately 15-30 minutes depending on the complexity of individual skin condition.
As of any surgical procedure, excision surgical biopsy has a small risk of bleeding and infection. As excision surgical biopsy involves removal the skin lesion entirely with possible involvement of deeper later of the skin, it has a risk of injury to surrounding tissue including nerve injury. Upon healing, there will be a scar over the biopsy site.
The major concern of excision biopsy over the face is the aesthetic outcome of scarring post procedure. The second important concern of facial excision biopsy is injury to facial muscle and nerve tissues- leading to facial palsy, asymmetrical face. Your doctor usually will discuss with you the risks of procedure versus the benefits/clinical indications of excision biopsy before planning the procedure.
You are advised to keep the excision site clean and dry for 24-48 hours. You can then shower, or bath as per normal (avoid soaking, scrubbing or swimming for over a week). Pat dry the wound after cleaning or shower. Your doctor usually prescribes you with antibiotic cream and Vaseline ointment which you can apply onto the wound. You can cover the wound with a clean water-proof light dressing.
You are advised to avoid exercise 3-7 days after the surgical excision procedure. This is to avoid wound dehiscence, and keeping the wound site clean and dry to reduce risk of bleeding and infection.
If your wound is red, swollen, weepy with pus discharge, you are developing systemic symptoms such as fever, worsening pain over wound site, do let your doctor know. You are usually followed up by your doctor in 2-weeks time after procedure to monitor the wound site.
This is depending on patients’ individual baseline medical condition, size and extend of the excision. Generally, the excision biopsy wound takes 4 to 6 weeks for healing. You should be able to return to your normal routine in life within a week.
Yes, there will be a scar (linear line) upon healing. Depending on location of the excision, and individual skin types, some patients may be prone towards hypertrophic scars or keloids. Your doctor will discuss with you the surgical outcome before the procedure.
Excision biopsy has double benefits of removing the whole abnormal skin lesion and confirming the microscopic findings/diagnosis of the skin condition at the same time. Although punch biopsy procedure allows microscopic understanding of the skin condition, it may or may not be able to remove the whole skin lesion. Excision biopsy involves a larger surface area wound, hence a longer healing time in comparison to punch biopsy.
Not necessarily, as excision biopsy procedure can be offered for benign skin lumps such as lipoma, epidermal cyst etc. As excision surgical biopsy removes the skin lesion at a deeper layer, it is a procedure that is suitable in certain skin cancers as it adequately removes the whole affected skin together with a ‘margin’ of surrounding healthy skin.