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Incisional Biopsy

Last updated June 2, 2021

Written by: Lester Fahrner, MD

Reviewed by: Lester Fahrner, MD

Approved by: Krish Tangella MD, MBA, FCAP

Incisional Biopsy is a procedure performed to remove a portion of a skin lesion, or an inflammatory process of the skin.

Background Information:

What are the other Names for the Procedure?

  • Partial Biopsy of Skin (Inflammatory Process)
  • Partial Biopsy of Skin (Lesion)

What is Incisional Biopsy surgical procedure?

  • Incisional Biopsy is a procedure performed to remove a portion of a skin lesion, or an inflammatory process of the skin
  • Incisional Biopsy deliberately does not involve removing a lesion in its entirety

What part of the Body does the Procedure involve?

The Incisional Biopsy procedure involves any portion of the skin of the body.

Why is the Incisional Biopsy surgical procedure Performed?

There could be a variety of reasons for performing Incisional Biopsy procedure. Some of these include:

  • If the nature of a skin lesion is not clinically certain, an Incisional Biopsy gives a larger amount of tissue for the pathologist to evaluate than a punch biopsy (or even several punch biopsies)
  • An Incisional Biopsy, performed with a scalpel, will give better representation of the deeper portions of a lesion than a shave biopsy would provide
  • Some benign lesions are large enough that an Excisional Biopsy, before knowing their biological behavior, would be excessive. If such a lesion could be safely watched clinically, the increased risks of scarring, infection, bleeding, and expense can be spared with the smaller, yet still definitive Incisional Biopsy procedure
  • If an Incisional Biopsy leads to a diagnosis of malignancy, there is generally adequate tissue to give an informed decision for definite treatment 
  • For inflammatory diseases, the lower portions of the skin (deep dermis) subcutaneous fat, and deeper vessels, will be present to give the pathologist and dermatologist extra insight into the disease

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Incisional Biopsy include:

  • Punch biopsy of the skin
  • Excisional biopsy of the skin

What are the Recent Advances in the Procedure?

Currently, no significant advances specific to Incisional Biopsy procedure are reported.

What is the Cost of performing the Incisional Biopsy surgical procedure?

The cost of the Incisional Biopsy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

  • It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the Incisional Biopsy procedure and what needs to be done
  • If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
  • Also, if the procedure involves multiple steps or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

https://www.aad.org/ (accessed on 05/16/2021)

Prior to Incisional Biopsy surgical procedure:

How is the Incisional Biopsy surgical procedure Performed?

The Incisional Biopsy procedure is performed in the following manner:

  • After local anesthesia and preparation of the site, a scalpel is used to remove an ellipse (shape) of skin, through the dermis and into the subcutaneous fat
  • A forceps is used to place the specimen in formalin
  • The surgical defect is sutured together, if feasible
  • Some inflammatory processes, such as severe infections or inflammatory diseases, lead to such weakened or fibrosed (firmly scarred) tissue that it must be bandaged and left to heal slowly

Where is the Procedure Performed?

The Incisional Biopsy procedure is usually performed in a clinic surgical suite or outpatient surgical suite.

Who Performs the Procedure?

The Incisional Biopsy procedure is usually performed by a dermatologist, dermatology physician assistant, or advanced practice nurse. Physicians of many other specialties may also perform Incisional Biopsies.

How long will the Procedure take?

The Incisional Biopsy procedure usually takes about 30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the procedure and helps avoid complications.

  • Provide medical history such as diabetes, hypertension, heart disease, etc. (if any)
  • Provide a complete list of medications you are currently taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
  • If you are allergic to any specific medication or food items
  • If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
  • Any medical or family history of bleeding disorders or blood clots
  • If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
  • Any unusual effects of anesthesia from prior surgery
  • A list of all previous surgical procedures you have undergone, like for example - removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

The physician performing the procedure will evaluate the patient prior to the procedure and discuss the details with risks for complications and obtain his/her permission (termed informed consent).

  • Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
  • Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
  • Blood work, glucose, and pregnancy tests (if applicable) will be undertaken per physician recommendations
  • If anesthesia team is involved in the procedure, then they too will discuss details of anesthesia with risks for complications and obtain permission from the patient (informed consent)
  • Avoid application of any deodorant or topical medicines on the area, prior to the procedure
  • It is advisable to quit smoking and the use of any nicotine based products, for a while, before the procedure
  • Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
  • Generally, the patient is required to be on fast (no solids or liquids) for at least 8 hours prior to the procedure
  • Individuals with diabetes, hypertension, or other cardiac conditions, are required to discuss these (including medications being taken) with their attending physician well in advance
  • For individuals with diabetes, it is important that the blood sugar stays within the normal range; if not, their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

Pregnant women and individuals with severe underlying sicknesses are advised to notify the staff team of their health status before this procedure.

What is the Consent Process before the Procedure?

The physician will obtain permission for the Incisional Biopsy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is the approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

In case of minors and individuals unable to give informed consent, the parent or legal guardian or next of kin can sign the consent for the procedure.

What Tests are needed, before the Incisional Biopsy surgical procedure?

In many cases, no tests are typically necessary prior to the Incisional Biopsy procedure. However, if required, the healthcare provider may recommend the following tests such as:

  • Blood and urine tests
  • Imaging studies

What are some Questions for your Physician?

Some of the questions that you might ask your healthcare provider are as follows:

  • What is an Incisional Biopsy procedure?
  • Why is this procedure necessary? How will it help?
  • How soon should I get it done? Is it an emergency?
  • Who are the medical personnel involved in this procedure?
  • Where is the procedure performed? 
  • What are the risks while performing the procedure?
  • What are the complications that might take place during recovery?
  • How long will it take to recover? When can I resume normal work?
  • How many such procedures have you (the physician) performed?
  • Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
  • What are the costs involved?

During the Incisional Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia by injection and occasionally general anesthesia by injection is administered for the procedure.

How much Blood will you lose, during the Procedure?

There is not much blood loss during an uncomplicated Incisional Biopsy procedure.

What are the possible Risks and Complications during the Incisional Biopsy surgical procedure?

There are general factors that increase one’s risk of getting complications during the Incisional Biopsy procedure, which include:

  • Obesity: Generally greater the degree of obesity, greater is the surgical risk
  • Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
  • Advancing age
  • Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
  • Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
  • Poorly functioning liver, as evidenced by increased blood liver function tests
  • Hypertension (increased blood pressure), especially if it is poorly controlled
  • Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
  • Poor lung function, as evidenced by abnormal lung function tests
  • History of bleeding disorders
  • Poor immune system due to a variety of causes

Some of the possible risks and complications that may arise during an Incisional Biopsy procedure are:

  • Infection
  • Bleeding
  • Injury to the neighboring structures
  • Pain
  • Discomfort
  • Anesthetic complications
  • Need for further procedures
  • Pneumonia
  • Heart problems

What Post-Operative Care is needed at the Healthcare Facility after the Incisional Biopsy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. However, immediately following the surgery, the patient may be kept in the office or surgical suite until safe ambulation and transport is ascertained. 

After the Incisional Biopsy surgical procedure:

What are the possible Risks and Complications after the Incisional Biopsy surgical procedure?

The risks and complications that may arise after Incisional Biopsy include:

  • Excessive bleeding that may sometimes require an additional surgical procedure
  • Any symptom that causes uneasiness such as nausea and dehydration
  • Low-grade fever
  • Infection of the surgical wound

What is the Prognosis after the Surgery?

The prognosis after an Incisional Biopsy procedure is usually excellent in a majority of individuals.

When do you need to call your Physician?

Do contact your physician or call 911 (or your local emergency number) based on the seriousness of any of the following symptoms:

  • Fever and chills
  • Severe pain
  • Shortness of breath
  • Bleeding or fluid discharge from the surgical wound
  • Nausea and vomiting
  • Signs of infection
  • Severe fatigue
  • Dizziness

What Post-Operative Care is needed at Home after the Incisional Biopsy surgical procedure?

At home, the following post-operative care is recommended after an Incisional Biopsy procedure:

  • Use a cold pack over the dressing to relieve pain due to the incision
  • Follow the surgical team’s written postoperative care and dressing change instructions
  • Take the prescribed medications following the procedure
  • Avoid any strenuous activity for a period recommended by the physician
  • Do not drive (post-procedure) for a period of 24 hours
  • Avoid smoking or drinking alcohol post-procedure
  • Continue old prescribed medications after checking with the healthcare provider
  • Avoid sex until complete healing has taken place (under advice by the physician)

How long does it normally take to fully recover, from the Procedure?

The time for recovery from the Incisional Biopsy procedure is typically two weeks, with full healing at 4 weeks. A severe inflammatory process as the reason for Incisional Biopsy will often result in much slower healing.

Additional Information:

What happens to tissue/samples (if any), taken during the Procedure?

The samples/tissue are usually sent to the microbiology and pathology departments in the hospital, and subsequently disposed as per the standard hospital protocol.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

  • The samples/tissue is processed in the laboratory under a pathologist's supervision
  • Slide(s) are prepared once the tissue is processed and this is examined by a pathologist and a pathology report issued
  • Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Incisional Biopsy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

  • The outpatient facility or hospital
  • The dermatologist
  • An anesthesiologist (if anesthesia was administered)
  • A pathologist 
  • The laboratory that process and stained the specimen for the pathologist to examine

The patient is advised to inquire and confirm the type of billing before the Incisional Biopsy procedure is performed.

Reviewed and Approved by a member of the DoveMed Editorial Board
First uploaded: June 2, 2021
Last updated: June 2, 2021