How to do a punch biopsy

Skin biopsy is one of the most important diagnostic tests for skin disorders. Punch biopsy is considered the primary technique for obtaining diagnostic full-thickness skin specimens.

   A patient who is referred to our ENT clinic is expected to have both a punch biopsy done as well as a photo. This 5 minute procedure will save the patient a trip to Hospital as well as allowing us to fast track a patient with a malignancy such as a squamous cell carcinoma. We appreciate there is a cost involved but it will provide in most cases an accurate diagnosis which will help both the patient and the specialist staff at the hospital.


You need
Local anaesthetic with adrenaline, ideally with a dental syringe and needle which is very quick and easy to use.
A punch. 2mm in most cases is sufficient, although you can use a 3mm. They cost about 8.00NZ$.
A small pair of fine forceps and iris scissors
An alcohol swab and a couple of gauze swabs.
Send specimen in formalin to the laboratory


I have not had problems with people on anticoagulants as the bleeding is minimal.


Below is a video of how to do it. (the patient has given permission to show this video)

Skin cancer surgery

The incidence of skin cancer continues to rise with the baby boomers reaching older age and the lack of sun protection when young.

In Northland we have limited Dermatology services so if the lesion is too large for a GP to remove, referral can be made to General surgery, ENT and occasionally Ophthalmology services, depending on the site.
Ideally all patients should have a photo and punch biopsy of the lesion before referral. The real importance for this is for those patients with a SCC and patients who are immunocompromised can be triaged for urgent treatment. I shall be posting a video on how to do a punch biopsy  shortly. Just a reminder that it is best not to punch biopsy a suspected melanoma. All melanomas should be sent to General surgery.

The ENT service has recently produced an Audit on the last 6 months of head and neck skin cancer cases. ---102(91%) cases with clear margins and 10(8.0%) with positive margins.(requiring a second procedure). These results are satisfactory compared with international series.

At a meeting today between the General Surgery and ENT departments it appears that at present waiting times are not too bad.  We shall keep an eye on this. Another area of concern is those patients having multiple lesions removed, require input from someone with knowledge and interest in preventative skin care. Cytotoxic creams and lotions are showing very good results in skin cancer prevention. Management are looking into this for us.

Allergic Rhinitis and skin prick testing

The most common allergic symptoms are congestion, runny nose, postnasal drip, watery eyes, and itching of the eyes or throat. Ear infections and sinus infections are often aggravated by allergies.

Skin testing for allergies is used to identify nasal allergens. It is performed by applying an extract of an allergen to the skin, scratching or pricking the skin to allow exposure.

•  A drop of extract for each potential allergen -- such as pollen, animal dander, or dust mite -- is placed on the skin and pricked into the epidermis. The subsequent wheal is measured.
• All adults and children over about 6-7yrs should have allergy testing if they have symptoms of allergic rhinitis. This is available at the local pathology lab and some practices. 
• The video above demonstrates this simple investigation.