# Shave & Saucerisation Biopsy

## Overview

This module describes how to perform a shave or saucerisation biopsy to sample the epidermis and superficial dermis. In a shave biopsy, a razor blade removes a superficial sample. In a saucerisation biopsy, a scalpel is used in a circular motion to cut a slightly conical disk of skin.

## Indications

1. Seborrheic keratoses

2. Verrucous lesions

3. Molluscum contagiosum

4. Non-melanoma cutaneous carcinomas

5. Pedunculated lesions and skin tags

6. Sites with a risk of poor cosmesis for fusiform excision, or with a risk of hypertrophic scarring

## Contraindications

1. Most pigmented lesions

2. Hairy naevi

3. Dermatoses involving deeper layers of the skin

4. Suspected sclerosing basal cell carcinoma (rather punch or saucerise)

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I need to take a sample of your skin lesion to find out what it is. The method is called a shave/saucerisation biopsy. I will use a small blade to shave off the upper layer of the skin. It will not need stitches.”

### What can my patient expect?

“I will give you an injection so that you will not feel me taking the sample. You may feel tugging and working in the area, but it will not be painful. The laboratory test may take a few days

or longer

or longer

Histology often takes 6 weeks for results. If urgent, call the pathologist directly to discuss and expedite.

, and we will then contact you about your diagnosis.”

### What is my patient’s role?

“Let me know if you have any allergies or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep still while I take the sample. Afterwards, keep the plaster on for at least a day.”

## Preparation

Prepare a trolley with equipment.

### Documentation

1. Patient notes

2. Patient labels

3. Histology forms

### Equipment

1. Sterile gloves

2. Alcohol-based hand rub

3. Sharps container
   Sharps container

   If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.

4. Two alcohol swabs

5. For saucerisation: a swab soaked in

   skin disinfectant
   skin disinfectant

   Commonly used preparations include 0.5-2% chlorhexidine in 70% alcohol (Steriprep), or 10% povidone iodine. There is no consensus on the superiority of one agent above another. Caution: chlorhexidine solutions may be associated with burns and skin breakdown in infants < 2 months old.

6. A 3 ml syringe

7. Gauze

8. Lignocaine

9. An aspiration needle (preferably blunt fill) and injection needle

10. For saucerisation: no 15 scalpel blade

11. For shave biopsy: double-edged razor blade

12. Silver nitrate stick
    Silver nitrate stick

    Ideally, have cautery available, Monsel's solution (ferric subsulfate) and aluminium chloride. Monsel's solution can rarely cause tattooing. Aluminium chloride slows wound healing. Silver nitrate can also cause tattooing.

    or other haemostatic agents

13. A gauze dressing and transparent film dressing

14. Specimen jar and formalin

## Site and Positioning

The patient should be positioned reclining or supine with the lesion within easy reach.

## Procedure

Follow medical asepsis with non-sterile gloves.

1. Perform hand hygiene. Don non-sterile gloves.

2. Clean the area with an alcohol swab (chlorhexidine/povidone iodine for saucerisation)

3. Pinch up the skin with your non-dominant hand and inject lignocaine under the base of the lesion.

4. For shaving: Steady the skin with your non-dominant hand and use the scalpel blade, held parallel to the skin, to shave off the lesion to the level of the dermis.

5. For saucerisation: hold the blade at a 45° angle and use a circular motion to cut away a conical disk of tissue.

6. Use direct pressure and the silver nitrate stick to stop bleeding.

7. Apply a gauze pad and transparent film dressing.

8. Dispose of medical waste safely.

9. Label a specimen jar of formalin, and send the specimen in it to the laboratory with a histology form.

10. Record completion of the procedure in patient notes.

## Risks

1. Local pain or excessive bleeding at the site

2. Infection at the site

3. Scarring

4. Sharps injury to healthcare personnel

5. Vasovagal response (fainting)

## References

1. Skin Biopsy Techniques: When and How to Perform Shave and Excisional Biopsy. Consultant. 2012(52):7. Available from: https://www.consultant360.com/article/skin-biopsy-techniques-when-and-how-perform-shave-and-excisional-biopsy

2. DiBaise M. Dermatologic Procedures. In: Essential Clinical Procedures, Third Edition. Philadelphia: Elsevier; 2013.