Shave Biopsy.

Often performed during a skin check.

Shave Excision is performed under local anaesthetic and is a method taking a superficial skin biopsy without the requirement for sutures.

What is Shave Biopsy?

Shave Biopsy is probably the most commonly performed type of skin biopsy in a skin cancer clinic. No sutures are involved, and it generally gives good pathology samples for most superficial skin lesions.

A type of razor- blade cuts through the upper layer of skin that approximates to the the epidermis and upper dermis.

A shave gives a better sample for the pathologist but does not allow for the “feel” of a curettage procedure (during curettage, the demarcation point between healthy and cancerous skin can be felt). So the decision to curet or shave a lesion will depend on the clinical certainty of the diagnosis using dermatoscopy.

The cosmetic outcome of a superficial shave is normally good – similar to the outcome of a curettage procedure.

Local anaesthetic is used before the blade is applied. The shave instrument is a disposable sterile surgical blade that allows skin to be cut through horizontally.

When is Shave Excision used?

Surgical removal of a Suspected superficial non-melanoma skin cancer (superficial BCC or IEC) may be perform by a shave excision or curettage with cautery.

There are a range of benign lesions that may be removed with a shave excision, although some types of lesion are more likely to grow back than others. Curettage (with cautery) may be a better option for some lesions such as pyogenic granuloma.

What is a Deep Shave Biopsy?

Another type of shave biopsy is a deep shave biopsy – also called a saucerisation biopsy. This type of shave excision takes a deeper out a deeper layer of skin (well into the dermis) – and is therefore used when a deeper layer of skin will be required by the pathologist.

A saucerisation biopsy will leave a more pronounced scar than a superficial shave. A saucerisation biopsy is an alternative to formal surgical excision in the management of some pigmented skin lesions. Australian and International Guidelines do emphasise that formal surgical excision is generally the better option for initial sampling of a melanoma. There are situations where a shave sample of a possible melanoma might be considered because guidelines cannot cover every scenario.

What are the risks of Shave Biopsy

As with a formal surgical excision, risks are infection, bleeding and scarring.

The degree of scarring, will depend on how deep the shave is performed, and factors such as age, location and physical activities. A saucerisation biopsy on the back of a physically active male is like take weeks to heal and is likely to scar significantly. A deep shave taken over the shoulders or front of the chest are most likely to cause a hypertrophic or keloid scar.

Shave excision below the knee in older people may take a long time to heal.

WRITTEN BY: Dr Richard Beatty