Skin biopsy

Skin biopsy is a procedure in which a certain area of the skin is removed and processed for detailed examination under a microscope. Let's consider the method features, technology and other nuances.

In the process of research, several methods are used, the choice of which depends on the size and location of the atypical site, which is to be removed as a sample. The biopsy is placed in a sterile container or special solution for further examination under a microscope. The main feature of the diagnosis is that no special training is required. In some cases, local anesthesia may be used to anesthetize.

After the procedure, which lasts for 5-25 minutes, a bandage or plaster is applied to the affected area to prevent infection. At the site of skin selection, painful sensations can occur, which occur after 1-2 days. If there is swelling on the wound site, bleeding, severe pain, discharge and other painful symptoms, you should seek medical help. This is due to the fact that the biopsy is accompanied by certain risks. First of all, this is a poor healing of wounds, bleeding, infection, scarring and nerve damage. The risk group includes patients with disorders of blood clotting and blood circulation problems, smokers and those suffering from immunodepression.

[1], [2], [3], [4]

Indications for a skin biopsy

Skin examination refers to diagnostic methods that are used to establish a specific diagnosis. With it, you can delete and study the area of abnormal skin. For this, a shaving, puncture and excisional biopsy is used.

The main indications for conducting:

• Diagnosis of bacterial, fungal or viral infections.
• Detection of inflammatory lesions.
• Suspicion of benign neoplasm.
• Check the condition of the skin at the site of tumor removal.
• Lupus erythematosus.
• Tuberculosis of the skin.
• Cancer.
• Psoriasis.
• Scleroderma.
• Amyloidosis.
• Deep mycosis.
• Nodular periarteritis.
• Darya's disease.
• Reticulosis.
• Control of the effectiveness of treatment.

When taking material for the study, pay attention to the localization of the lesion. The necessary sample is placed in the solution, and if there are suspicions of infection in a sterile container. The tissues are processed and studied under a microscope for pathologies.

Most often, the diagnosis is made for the detection of cancer, which is accompanied by a change in pigmentation and poor wound healing. Timely detection of the disease allows for early treatment, warning of possible consequences.

Skin biopsy tool

A skin biopsy is performed using a special instrument. There are many methods of conducting diagnostics, therefore the equipment used differs. Typically, this is a one-time tool kit that contains a cannula with a hole, a probe and a movable tube that is installed in the cannula. At the end of the tube, a special rim in the form of a ring, used to insert into the hole in the wall and hold the tissue sample. The probe is placed in a cannula, at the ends of which there are tubes with heads. If necessary, the heads are connected. This reduces traumatism in the sampling process and preserves its macroscopic and microscopic properties.

When puncture biopsy tissue is extracted with a special needle. It has a few centimeters in the din, and a syringe cylinder with a diameter equal to the usual clip. Inside the needle is hollow, which allows you to extract and capture tissues. The peculiarity of the tools is that they have a wide range of sizes for taking samples from any part of the skin. The ribbed handle allows you to securely hold in your hand and monitor the procedure. All instruments are absolutely sterile (excludes infection), they have a steel sharp razor for minimal traumatization of tissues.

Skin biopsy needles

Several types of needles are used for biopsy:

• A thin needle with a syringe (thinner needles to draw blood from the vein).
• Automatic, cutting with a spring mechanism. It consists of a thick needle that is inserted into a cell with a sheath attached to the mechanism.
• Vacuum for aspiration biopsy - allows you to take large samples of tissue.

The diameter of the needle can be from 2 to 8 mm. If whole segments of tissue are taken for histological examination, then use a hollow needle. It contains a cannula with an edge or a special probe for cutting the tissue and inserting it into the selected part of the body. The biopsy is placed in a cylindrical canal and held there by suction or mechanical means. The resulting sample has an elongated cylindrical shape. Samples should reflect the structure of living tissue as accurately as possible.

There are special automated devices used for puncture biopsy. This technology was called the "needle of the correct cut". It contains a cannula with a sharp edge and an internal probe with a semi-cylindrical depression near the point. A significant drawback of this tool is that it allows you to take tissues, the volume of which is equal to half the volume of the cannula. In addition, the quality of the sample deteriorates, since the probe passes through the area under investigation.

Method of skin biopsy

The method of the study is the excision of a small area of the skin or the selection of tissues under local anesthesia for further study. To date, three methods are used:

• Shaving

Using a scalpel or a special blade, a surface cutoff of the lesion focus is taken. That is, the protruding part of the pathological element is cut off and placed in a formalin solution. The cut site is treated with a sterile tissue to prevent bleeding.

• Trepanobiopsy

Using this method, a column of tissue with skin and subcutaneous fat is taken from the central part of the affected area. In the area of the procedure, the skin is stretched and pierced with a trepanation needle, gradually rotating it around its axis. The needle is removed, and the formed column of tissue is tightened with tweezers and cut at the level of fat. If the wound surface does not exceed 3 mm in diameter, then a sterile patch is applied to it. If the diameter is larger, a seam is applied.

• Excision

The lesion focus and the healthy area adjacent to it are excised with a special tool. The method is used for suspected malignant tumors. For the study, choose a biopsy with pronounced changes (discolored skin, on which the wounds do not heal well). The wound surface is treated with a sterile wipe to prevent infection and bleeding. The wound is sutured, if the defect is large, then a skin graft is used to close it.

The results of the study are influenced by such factors as:

• Sampling of the sample without pathological changes or with minimal deviations.
• Use of a non-sterile container or improper fixation of the material and its damage.

The main purpose of the above methods is differential diagnosis of benign and malignant lesions, identification of chronic fungal and bacterial infections. The resulting material is immediately sent to the laboratory.

Skin biopsy

The study of the skin of the head is a sampling of tissue for histological analysis. Using a special needle, the doctor cuts out a piece of 2-4 mm, which after special treatment is studied under a microscope. The entire procedure is performed under local anesthetic, so the patient does not experience discomfort or pain.

On the wound surface, seams are applied, which are removed after 3-7 days. It is not recommended to wash your hair for the first two days to prevent infection or suppuration of the wound. Such excision is considered the most reliable method in diagnosing skin and dermatological diseases.

The operation is performed to clarify the diagnosis when a rash appears on the head or when scarring is present. The analysis reveals infectious, fungal, viral or bacterial lesions, as well as various autoimmune diseases. The procedure is carried out with wounds and burns of varying degrees.

[5],

Facial skin biopsy

If you suspect a malignant disease or other damage to the skin of your face, an operation is performed, during which a small part of the tissue is taken for examination. Before excision it is necessary to stop taking medications that promote bleeding, anti-inflammatory drugs and anticoagulants.

The procedure can be prescribed for suspicion of cancer, psoriasis, amyloidosis, nodular periarteritis, lupus erythematosus and other diseases. The area under investigation is thoroughly washed and treated with an alcohol solution of iodine or ether.

• As a rule, the procedure is carried out by the method of thin cutting, that is, using a scalpel, a thin layer of skin is removed. On the wound, a sterile patch is applied for self-healing.
• In some cases, a puncture biopsy is used with a special needle. This method allows you to take deeper layers of the skin and subcutaneous tissue. On the wound, a cosmetic suture is applied.

The resulting material is studied under a microscope to reveal differences in cells (cytology) and tissues (histology). To avoid painful sensations, the operation is performed under local anesthesia. Typically, this is a superficial anesthesia, that is, spraying the drug and freezing the site through which the needle passes. The analysis can cause a number of complications: inflammation, keloid scars. The results have to wait 1-6 weeks.

[6], [7]

Skin biopsy with psoriasis

With suspicions of psoriasis, the patient is waiting for a lot of tests and diagnostic procedures, including skin excision for histology and cytology. As a rule, it is not difficult to detect psoriasis, since the characteristic kind of tissues testifies to the disease. If the disease has an active, progressive or severe course, then standard blood tests reveal endocrine and biochemical disorders.

In this case, the patient is assigned a diagnostic excision to exclude other diseases and a histological confirmation of psoriasis. During the study of affected tissues, Reete body masses are found, that is, histological immaturity and thickening of the keratinocyte layer, increased proliferation and accelerated angiogenesis in tissues under the plaques.

Another characteristic sign of the disease that manifests itself during the analysis is spot bleeding under the skin with a plaque when trying to scrape it off. This is due to pathological increased permeability, ease of vessels in the lesions and accelerated angiogenesis.

Biopsy of neoplasm of skin

The study of neoplasms on the skin is performed with the help of an operation, during which the tissues are taken for examination. Subcutaneous and skin tumors are often found, so require a thorough examination and early diagnosis. There are several ways to take a tumor sample. The doctor chooses the most suitable, considering a number of factors, that is localization, possible diagnosis and cosmetic effect. All received samples are sent not only to cytology and histology, but also to morphological research.

Methods for taking a biopsy specimen:

• Using a scalpel, a thin cut of the epidermis and the upper layer of the dermis is made. With this procedure, the wound does not require suturing. With this method, you can completely remove a small tumor, and from a large sample take the material for the study.
• For puncture biopsy special needles with a diameter of 1-6 mm are used. During the operation, a column of underlying tissues is obtained. The method is excellent for examining large tumors. With it, you can completely remove the tumor if its diameter is less than the diameter of the needle. The wound is sewn up. The technique is not used to diagnose or remove neoplasms, in adipose tissue.
• The incision study is the excision of part of the tumor with the seizure of the epidermis, dermis and subcutaneous tissue. This allows for a histological analysis. The wound is sutured.
• Total research is the complete removal of the tumor and histology. For analysis, take all layers of the skin. If there is a suspicion of a malignant degeneration, the edge of the excised tissue is marked by threading. In the future, this facilitates the re-operation, since the doctor will be able to recognize the malignant area.

Before the operation, the wound surface is treated with an anesthetic. For this purpose, use 1% lidocaine or a mixture of adrenaline with lidocaine.

[8], [9], [10], [11]

Skin biopsy with histological examination

Histological examination is one of the main methods for detecting skin diseases. Histology is carried out by the method of tissue sampling from the affected area. This allows differentiating different lesions, which greatly simplifies the process of determining the ailment. The main rule of taking a biopsy is to choose a place for his fence. The material should be with subcutaneous fatty tissue.

The biopsy is treated with a formalin solution that can retain the tissues for months without damaging it. As a rule, excision excision is used. Material is taken with a special needle or scalpel. The resulting tissue is examined by light, electron microscopy or immunofluorescent staining.

Care of the wound after a skin biopsy

After the removal of the skin, special care is required to examine the wound surface. Depending on the size of the wound, it is possible to use a sterile dressing for several days. In some cases, immediately after the procedure or the next day, the place from which the biopsy was taken bleeds. In this case, seek medical attention.

After a puncture and excision biopsy, a small scar remains on the body. If it is on the neck, back or chest, it becomes a cause of discomfort, including cosmetic. Healing takes several weeks, but the wound is delayed 1-2 months. If the tissue was taken from the upper or lower extremities for the study, then they heal much more slowly than on other sites.

While the skin heals, it is necessary to take care of it properly:

• Before you touch the wound, you need to wash your hands thoroughly with soap and water.
• The surface must be treated with an antiseptic and covered with a sterile bandage or adhesive plaster.
• The wound should be dry and clean.
• Do not immerse the affected area in water until the tissues have healed well.
• Continue care until the tissue is completely restored or until the seams are removed.

If there are signs of infection after the operation, that is, fever and chills, swelling, bleeding, discharge or pain, then you should seek medical help. In this case, the patient is prescribed painkillers and anti-inflammatory drugs. When applying seams, they remain for 3-14 days, depending on the location of the wound.

[12], [13], [14], [15], [16]

Can I wash myself after a skin biopsy?

In many patients who have been assigned diagnostic excision of skin, the same question arises: can I wash and wet the affected area immediately after the procedure.

• If the excision of the upper layer of the epidermis and the dermis was used for the study and the patient does not feel severe pain, the wound can be moistened. After water procedures, it is necessary to apply an antiseptic to prevent infection.
• With a puncture fence on the wound, sutures are applied, so it is not recommended to wet the affected area for 1-2 days.
• The skin can not be stretched, as this can cause bleeding, increase the wound, which in the future will lead to the appearance of a scar.

Complete healing occurs within 1-2 weeks.

[17], [18]

What can I do to treat a wound on my face after taking a skin biopsy?

If a biopsy specimen was taken from the face, then it is necessary to know how to speed up the healing. To treat the wound, it must be treated with an antiseptic, for example, a green. During the recovery period it is better to spend a couple of days at home, in order not to feel discomfort from the constant views of others. Of course, if we are talking about a large wound surface and the problem is aesthetic.

After a skin biopsy, wound healing ointments (Panthenol, Actovegin, Bepanten) or cream are used to care for the damaged surface. Such medicines accelerate healing and give a good cosmetic effect. Local drugs have anti-inflammatory and bactericidal effect, remove redness and irritation.

Patient's consent to a skin biopsy

If there are indications for a biopsy, then before it is carried out, the patient is agreed and warned about possible risks and complications. The doctor's task is to explain that the study is a study of a piece of flesh on various infections. The patient is explained the essence of the method and answers all the questions of interest. The procedure does not require special preparation or compliance with the diet.

Since local anesthesia can be used to prevent pain, it is necessary to find out whether the patient has intolerance to the anesthetic.

Before diagnosis, the patient should notify the doctor about the following:

• Taking medications, especially anti-inflammatory drugs, as they affect the results of the study.
• Presence of allergy to certain drugs.
• Problems with bleeding and taking medications to dilute blood (Warfarin, Aspirin, Coomadine).
• Pregnancy.

With regard to risks and complications, it is bleeding, infection, pain, prolonged healing of the wound. After this, the patient must sign a consent form.

Cost of a skin biopsy

The cost of diagnostic excision of the skin depends on the applied histological examination. The procedure is costly and costs 300-5000 UAH, depending on the site of the material intake and on the diagnosis of the alleged disease.

• Punch study of the skin of the trunk and extremities - from 600 UAH.
• Fence material from the face, neck, hands, feet or genitals - from 700 UAH.
• Excision surgical excision - from 800 UAH.
• Pathological study of the biopsy - from 500 UAH.

Sampling is carried out in specialized clinics. The study of tissues is carried out both in Ukrainian laboratories and sent to diagnostic centers outside the country. The results of the analysis are provided within 1-6 weeks.

[19], [20]