Basal Cell Carcinoma Excision

Punch Skin Biopsy

What is a Punch Skin Biopsy?

A punch biopsy is the major method used to aid in the diagnosis of skin disorders. It is a out-patient surgical procedure, that is performed to obtain a full-thickness skin specimen.

Once the Consent form is signed, the medical assistant can begin to prepare the area of skin that has been marked by the physician and gather materials needed for anesthesia and the surgical procedure. Any skin antiseptic such as isopropyl alcohol can be used to clean the skin.

Once the area is selected the Medical Assistant is to explain the procedure to the Patient and Have the patient sign a Consent form.

Anesthesia Non-Sterile Tray

• Labeled formalin container
• Non-sterile gloves
• 3-mL syringe filled with 2 percent lidocaine with epinephrine (Xylocaine with epinephrine) and a 30-gauge needle

Punch Biopsy Sterile Tray

• Sterile gloves
• Needle holder for suturing
• Iris scissors
• 21-gauge, 1¼-inch needle for elevating the specimen,
• Sterile drape
• punch biopsy instrument (3 or 4 mm)

How is a Punch Biopsy Performed?

The area where the biopsy will be performed is to be selected by the physician with the consent of the patient. While the site is being selected the medical assistant is to gather the materials needed.

References:

Doc-stoc Punch Biopsy Post Procedure Instruction. N.p.: http://www.docstoc.com/, 2010. N. page. Web. 7 July 2014.

Mayo Clinic. Skin Biopsy. N.p.: Mayo Clinic, 2011. 1-3. Web. 7 July 2014. <http://www.mayoclinic.org/tests-procedures/skin-biopsy/basics/what-you-can-expect/prc-20014632>.

AAFP. Punch Biopsy of the skin. N.p.: n.p., 2002. Web. 7 July 2014. <http://www.aafp.org/afp/2002/0315/p1155.html>

Once the physician is finished suturing the wound the medical assistant will place a bandage with antibiotic ointment. The physician will then Depending on the site allow patient to become dressed and then explain post-care.

Post-Care Instructions For Punch Biopsy

• Bandage may be removed 24hrs after biopsy.
• Wound must be washed twice daily with a unscented soap.
• after cleaning the wound apply bandage with antibiotic ointment.
• return for suture removal.

Thank You!

Now that the procedure has been discussed and explained to the patient and a consent form has been signed, materials have been gathered and the site has been chosen the medical assistant can prepare the patient for the procedure. Depending on the area the medical assistant may have to drape the patient. Once the patient is properly draped the medical assistant will administer the local anesthesia to the patient at the site deemed appropriate by both the physician and the patient.

• The physician will then proceed to performing the punch biopsy. The physician will don on his sterile gloves, stabilize the skin slightly stretching to produce an oval wound to facilitate closure. Taking the punch the physician will apply constant, firm, downward pressure in a circular motion. Once the punch has reached the subcutaneous fat layer the physician will remove the punch and apply downward pressure at the sides of the wound to pop up the core the physician will take either forceps or a needle to completely elevate the core and excise at the base using small tissue scissors. Pressure must then be applied with gauze to prepare for closure. The physician will then procedure to applying sutures to the wound.

MDA 130

Andrea Miranda