What are the risks associated with a skin biopsy?

An accurate diagnosis of pityriasis rubra pilaris requires a proper skin biopsy.

✽   A skin biopsy is the most common and also the most essential procedure performed by a dermatologist in day-to-day practice. It is safe and easy, with not only diagnostic purpose, but also has significant therapeutic value. It is performed as an office procedure both on an outpatient and inpatient basis. Though it is one of the simplest procedures to perform, occasionally we come across complications related to skin biopsy.”

✽  A skin biopsy is the most important diagnostic procedure for a dermatologist. However, awareness about the possible complications that can arise due to this small procedure helps in better outcome for the patients and less hassles for the dermatologist.

✽  A skin biopsy is usually straightforward and complications are uncommon. As a general rule, the larger the skin sample removed, the higher the chance of complications.

✽  You should discuss with your doctor the following potential risks and complications of the biopsy procedure. You may need to sign a consent form before the procedure is performed.

✽  In order to prevent or reduce complications it is necessary for your dermatologist to conduct a physical examination and take a complete history before performing a skin biopsy. The detailed history should specifically  identify medications that can cause prolonged bleeding, increase risk of infection or delay healing.

Possible risks include the following:

PAIN

✽  Mild pain is usually experienced during skin biopsy. Severity of pain may vary according to the site where biopsy is being performed.

✽  You will feel brief stinging pain when the local anesthetic is injected. You should not feel any pain when the skin sample is removed.

✽  Occasionally pain can be more severe if there is:

✽  Inadequate local anesthetic injection.

✽  Short time gap between injecting the anesthesia and performing the procedure.

✽  Wrong site of application of anesthesia.

✽  Inadequate depth of applying anesthesia.

BLEEDING

✽  Although unlikely, there is a slight risk of  of persistent bleeding.

✽  Bleeding can occur in anyone, but can be particularly troublesome in those with a bleeding tendency, or taking blood-thinning medications such as warfarin or aspirin.

SCARRING

✽  If you usually form scars after skin injuries or surgery, you could develop a scar at the biopsy site.

✽  Smoking and some chronic medical conditions such as diabetes affect the healing ability of the skin.

✽  It is usual for a biopsy site to form a significant permanent scar. Some body sites such as the centre of the chest are prone to develop excessive scars. This is also more common in Afro-Caribbean skin types.

INFECTION

✽  There is a slight risk of Infection.

✽  Bacterial wound infection affects about 1–5% of excisional biopsies. It is however extremely uncommon in small punch, shave or incisional biopsies.

✽  Ulcerated or crusted skin lesions, site of biopsy, patient characteristics such as diabetes, older age, or use of immunosuppressive medicines may contribute to increased risk of infection.

NERVE INJURY

✽  The blade may cut a superficial sensory nerve causing pain or numbness. This is most likely to occur where the skin is thin, for example on the face or back of hand. Risk of motor nerve impairment is extremely rare, but can occur during skin cancer surgery in facial danger zones.

ANESTHETIC PROBLEMS

✽  Allergies to local anesthetics are a possibility but are also extremely rare.

Sources used in preparing this post

✽  Kumar Abhishek and Niti Khunger; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728909/

✽  http://www.dermnetnz.org/topics/skin-biopsy/

✽  http://www.webmd.com/cancer/what-is-a-biopsy#1

✽  http://www.medicinenet.com/skin_biopsy/article.htm

Have you experienced any complications related to skin biopsies?

02.03.05