Background Information:

What are the other Names for the Procedure?

• Shave Biopsy of Skin

What is Shave Biopsy surgical procedure?

• Shave Biopsy is a procedure in which a sharp instrument is used to remove a very superficial specimen of skin for diagnostic purposes
• The skin sample is placed in formalin or other transport medium and sent to the appropriate pathology lab for investigation
• The skin problem being addressed can either be a rash or other inflammatory process of the skin, or a benign or malignant growth

What part of the Body does the Procedure involve?

The Shave Biopsy procedure can be performed on almost any of the accessible skin surfaces.

Why is the Shave Biopsy surgical procedure Performed?

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

• Establishing a diagnosis between different rashes and inflammatory diseases of the skin
• Establishing a diagnosis between a variety of benign skin growths under clinical consideration
• Help in making the diagnosis of whether a pigmented lesion is benign or malignant
• Help in making the diagnosis of a benign or malignant specimen when evaluating a lesion without pigment
• In a situation in which an experienced practitioner considers a lesion very likely to be malignant, which subtype is present

When a small elevated lesion (papule) is likely to be benign, and there is a reason to remove it despite the likely diagnosis, Shave Biopsy can give diagnostic confirmation, through a specimen for the pathologist, as well as a very high chance of an excellent outcome after healing.

What are some Alternative Choices for the Procedure?

Some of the alternative choices for Shave Biopsy include:

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

What are the Recent Advances in the Procedure?

A recent advance involves the development of a disposable sterile flexible sharp blade with a plastic handle on each side. This is held between the thumb and forefinger of the surgeon. It adds an element of safety for the surgeon and assistant, as well as the sterile aspect makes surgical site infection slightly less likely.

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

The cost of the Shave 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 Shave 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.aafp.org/afp/2011/1101/p995.html (accessed on 05/16/2021)

https://www.cancer.ca/en/cancer-information/diagnosis-and-treatment/tests-and-procedures/shave-biopsy/?region=on (accessed on 05/16/2021)

Prior to Shave Biopsy surgical procedure:

How is the Shave Biopsy surgical procedure Performed?

The Shave Biopsy procedure is performed in the following manner:

• The Shave Biopsy is a clean, but not a sterile procedure. Hence, the skin is prepped with isopropyl alcohol, and a local anesthetic is injected
• Between 2-4 cm width around the skin site is stabilized by gentle tension, by the surgeon’s off hand or the assistant
• The blade is used with a superficial deft tangential slice across the base of the lesion to be sampled off, or the patch of rash or dermatosis to be biopsied
• Minor bleeding is controlled with aluminum trichloride or light cautery. A small bandage is applied
• The blade chosen for the procedure is either a sterile scalpel, a flexible blade developed expressly for shave biopsies, or a flexible double-edged razor blade. The latter is the one that is frequently used
• For delicate thin skin, where stabilizing the tissue with tension is not feasible, other means are used. These sites would include upper and lower eyelids, genital skin, and mucosal surfaces
• At these locations, sometimes a fine needle is used to pierce and elevate the skin, and a blade or very delicate scissor used to separate off the specimen

Where is the Procedure Performed?

The Shave Biopsy procedure is usually performed in a clinic examination room, surgical room in a clinic, or hospital bedside.

Who Performs the Procedure?

A physician, physician assistant, or advanced practice nurse usually performs the Shave Biopsy procedure.

How long will the Procedure take?

The Shave Biopsy procedure usually takes about five minutes. The time to evaluate the patient, the rash or lesion is quite variable.

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 medications
• 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
• Any unusual effects of local anesthesia

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).

• Avoid application of any topical medicines on the area, prior to the procedure
• If cautery might be used for bleeding control, inform your medical team if you have a pacemaker, defibrillator, implanted pain relief device, or deep brain stimulator, or cochlear implant 

What is the Consent Process before the Procedure?

The physician will obtain permission for the Shave 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 Shave Biopsy surgical procedure?

In many cases, no tests are typically necessary prior to the Shave Biopsy procedure. However, if required, the healthcare provider may recommend blood tests regarding post biopsy bleeding risk.

What are some Questions for your Physician?

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

• What is a Shave 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?
• What sort of scar should I anticipate?

During the Shave Biopsy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Generally, local anesthesia by injection is used for the procedure.

How much Blood will you lose, during the Procedure?

Shave Biopsy is considered a minimally-invasive procedure, and there are no risks for significant bleeding during this procedure.

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

Some of the possible risks and complications that may arise during a Shave Biopsy procedure include:

• Bleeding
• Nausea or faintness
• Pain

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

At the healthcare facility, generally there is no requirement for any post-procedure care, unless nausea, bleeding, or fainting arise.

After the Shave Biopsy surgical procedure:

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

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

• Excessive bleeding that may sometimes require an additional attempt at controlling the bleeding

• Infection of the surgical wound
• Allergic reaction to wound care adhesives, antiseptics, or topical agents

What is the Prognosis after the Surgery?

The recovery from the Shave Biopsy procedure is usually excellent. 

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:

• Severe pain at the site
• Bleeding or fluid discharge from the surgical wound
• Signs of infection

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

At home, the following post-operative care is recommended after a Shave Biopsy procedure:

• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild unscented soap
• Follow the local wound care instructions from the office
• Take the prescribed medications following the procedure
• Avoid any strenuous activity for a period recommended by the physician
• Continue old prescribed medications after checking with your healthcare provider

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

The time for recovery from the Shave Biopsy procedure is typically one to two weeks. It depends on the location, intercurrent infection, and health of the patient

Additional Information:

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

The tissue is taken for further examination and later disposed, as per the standard medical procedure.

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 Shave 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
• A pathologist 

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