When shave biopsy is commonly used

A shave biopsy is often chosen for lesions that are primarily in the top layers of the skin or that are raised above the skin surface. It is commonly used for many benign-appearing growths, superficial basal cell carcinomas, irritated seborrheic keratoses, warts, and some suspicious lesions where a superficial sample is diagnostically appropriate. In selected situations, a “deep shave” or saucerization technique may be used to sample deeper tissue.

How it is performed

After numbing the area, the dermatologist uses a small blade to remove a thin layer of skin. Depending on the goal, the sample may be shallow (superficial shave) or slightly deeper (saucerization). Bleeding is typically controlled with a cautery device or a topical hemostatic solution, and stitches are usually not needed.

What recovery is like

A shave biopsy typically heals like a scrape. The site often forms a scab and then gradually re-epithelializes over about 1–3 weeks, though healing time varies by body location and size. Mild tenderness for a day or two is common. Because it heals from the edges inward, a temporary pink spot may remain for several weeks and gradually fade. Sun protection over the area supports better cosmetic healing.

When punch biopsy is commonly used

A punch biopsy is commonly used when a full-thickness sample of skin is needed. It is frequently performed for inflammatory rashes (such as eczema, psoriasis-like eruptions, vasculitis, or other dermatitis patterns), small lesions that require depth for diagnosis, and conditions where sampling the dermis is essential. Punch biopsies are also used when clinicians need a consistent, cylindrical specimen for pathology interpretation.

How it is performed

After local anesthetic, a circular punch tool—often a few millimeters in diameter—is pressed and rotated through the skin to obtain a small “core” that includes epidermis and dermis and may extend into superficial fat. The sample is lifted out and cut free. Depending on the size and location, the site may be closed with one or more stitches.

What recovery is like

If stitches are placed, the wound is usually protected with ointment and a bandage. Tenderness is typically mild and short-lived. Stitch removal timing depends on location (commonly sooner on the face and later on the trunk or extremities). Healing generally takes 1–2 weeks for initial closure, with scar maturation continuing for several months. A small round scar is common, and careful wound care can help minimize it.

When incisional biopsy is commonly used

An incisional biopsy removes only a portion of a lesion and is used when a growth is large, deep, or located in an area where complete removal is not ideal at the initial diagnostic step. Incisional biopsy may be selected for thicker tumors, ulcers, or plaques where sampling the most representative area will provide a diagnosis before planning definitive treatment.

How it is performed

After numbing, the dermatologist uses a scalpel to remove a wedge or elliptical section of the lesion, typically including the edge and center or the most diagnostically informative area. The site is usually closed with stitches. The approach aims to obtain adequate depth while preserving surrounding tissue for future treatment if needed.

What recovery is like

Recovery is similar to a small surgical incision. The area may feel sore for several days, and activity modification may be recommended depending on location. Stitches are often removed in about 1–2 weeks depending on the site. A linear scar is expected, and scar appearance typically improves over several months as it remodels.

When excisional biopsy is commonly used

An excisional biopsy removes the entire lesion and is often used when complete removal is preferred for diagnosis and treatment at the same time. It is commonly used for suspicious moles (when appropriate), certain skin cancers, cysts, and other growths where full evaluation of the lesion’s architecture and margins is important. Excisional biopsy is also frequently chosen when the lesion is small enough to remove fully without creating excessive tension or distortion.

How it is performed

After local anesthesia, the dermatologist removes the entire lesion with a scalpel, often in an elliptical shape to allow a neat closure. The specimen generally includes full thickness of skin, sometimes extending into the fatty layer for adequate depth. The wound is then closed with stitches, typically with deeper dissolving sutures and superficial sutures or skin adhesive depending on location.

What recovery is like

Excisional biopsies heal like a minor surgical procedure. Mild swelling, bruising, and tenderness are common in the first several days. Stitches are usually removed in about 1–2 weeks depending on body site, while deeper sutures dissolve on their own. Activity restrictions may be recommended to prevent wound pulling, especially on the back, shoulders, legs, or other high-tension areas. A linear scar is expected and continues to mature and fade over months.

What happens after a biopsy

After any biopsy type, Peak Skin Center sends the specimen to pathology for microscopic review. Once results return, Dr. Thomas Knackstedt and the clinical team discuss what the diagnosis means and whether additional treatment is needed. Some benign results require no further action, while precancerous or cancerous results may lead to treatment options such as in-office excision, Mohs surgery, or field therapy depending on diagnosis and location. Peak Skin Center prioritizes clear guidance on wound care, scar expectations, and next steps, helping patients understand both the process and the plan following biopsy results.