1. Biopsy Techniques Jeffrey C. Page, DPM Arizona School of Podiatric Medicine Midwestern University

5. Importance of Timely Biopsy

6. Is One Enough?

7. Incisional Excisional Nail Shave Curettage Punch Excision Biopsies

8. Instrumentation

9. Incisional Biopsy • Removes only a portion of the mass • Sample the center of the mass • When biopsying an ulcer, include normal tissue, border, and ulcer bed • Not recommended for melanoma Pyoderma Gangrenosum Psoriatic Plaque

10. Excisional Biopsy • Pick fresh lesions that are fully developed • Remove the entire lesion • Must have a clear border of normal tissue • Needs pathologic analysis to confirm that borders are clear Squamous Cell Basal Cell

11. Shave Technique • Used most often with benign lesions • Best with raised lesions • Infiltration beneath a lesion can lift mass and make it easier to shave. • May be incisional or excisional

12. Punch Technique • May be incisional or excisional • 4mm or greater may require primary closure • Clean with alchohol, sterile technique not required • Anesthetize with local containing epi • Apply pressure or Monsel’s solution to stop bleeding

13. Punch Technique

14. Curettage Technique • An excochleation technique • “Scoops” the lesion intact from the surrounding tissue • Useful for verrucae and porokeratoses

15. Blunt Curettage

16. Electrofulguration & Electrocautery

17. Mohs Surgery

19. Structure and Function of the Nail

20. Structure and Function of the Nail

21. The Nail Unit

22. Pigmented Longitudinal Streak

23. Glomus Tumor of the Matrix

24. Mucoid Cyst of Proximal Nail Fold

25. Excision of Mucoid Cyst

26. Healing of Mucoid Cyst Excision

27. Pigmented lesion in the Matrix