For shave biopsy, a flexible blade or obliquely oriented curette or scalpel is used and the scalpel blade enters the skin tangentially, slides below the lesion, parallel to the skin to the opposite side. For saucerization biopsy, the blade enters and exits the skin in a similar fashion but the blade is bent to increase the depth of excised tissue. A sharp curette may be used to scrape and smooth the dermis and remove any residual lesion. Bleeding can be controlled using electrocautery, aluminum chloride, or Monsel’s solution.
For an excision, the area is cleansed and a local anesthetic injected. A margin of healthy tissue is identified and a full-thickness incision is made through the dermis. The incision is carried around the lesion and the entire lesion is excised. Separately reportable frozen section may be performed at the time of the excision to ensure that an adequate margin has been excised. If malignant tissue is identified at the margin, additional tissue is excised until all margins are clean. The lesion is sent to the laboratory for separately reportable histologic evaluation. Bleeding is controlled by electrocautery or chemical cautery. The wound may be closed using simple single layer suture technique. Separately reportable intermediate (layer) closure, complex repair, skin graft, or pedicle flap may also be used to close the surgical wound.
