Does It Hurt To Get a Skin Biopsy?
Key takeaways:
A skin biopsy is a medical procedure. During it, a small piece of skin is removed and examined to diagnose or rule out certain skin conditions, such as skin cancer.
During a skin biopsy, the area is numbed with an anesthetic to reduce pain and discomfort.
There are different types of skin biopsies. The type depends on the suspected condition and the needed tissue depth.
Tricia Schmorde is somewhat of a skin biopsy expert — not by profession, but out of necessity. Three generations of women in her family — her mother, herself and her daughter — have all had melanoma, an aggressive form of skin cancer.
Tricia, a 51-year-old veterinary technician from Eugene, Oregon, has had dozens of biopsies over the years. A skin biopsy is a minor surgical procedure where a tissue sample from the skin is removed and then sent to a lab, where a pathologist examines it.
Sometimes Tricia’s results come back negative for skin cancer, but further treatment is usually needed. “Ninety-seven percent come back as something atypical,” she says.
Three years ago, Tricia had a melanoma on her chest removed. She’s had chemotherapy on her lips 11 times and close to 20 excision procedures to remove larger areas of irregular skin.
For Tricia, the question, “Does it hurt to get a skin biopsy?” doesn’t even cross her mind. She’s more focused on how soon the biopsy can be scheduled and what the results will be.
“Melanoma can be deadly within as little as 6 weeks. Squamous cell carcinoma [a type of skin cancer] is another one that can metastasize [spread] quickly if you don’t get it taken care of,” Tricia says. “The [discomfort] of not getting a biopsy compared to a melanoma taking your life is minuscule.”
What does skin cancer look like? These pictures show how cancerous spots may look.
Are dermatology procedures covered by insurance? Insurance usually covers medically necessary procedures but not cosmetic ones.
Should I wear sunscreen every day? Experts say there are benefits to using sunscreen daily.
What do shave, punch, and excision biopsies feel like?
There are three main types of skin biopsies.
Shave biopsy: The top layers of the skin are shaved off with a small surgical blade.
Punch biopsy: A deeper sample of skin is removed with a small round tool, and the edges of the biopsy are often stitched together.
Excisional or incisional biopsy: An entire tumor, or portion of the tumor, is removed with a surgical knife from the deeper layers of the skin. The edges of the wound are then stitched back together.
Tricia has had all three types of biopsies.
The sooner a suspicious-looking mole or suspected skin cancer lesion is dealt with, she says, the less painful the procedure. A shave or punch biopsy has a much quicker recovery time than an excision.
“It’s no worse than a little scratch on your arm,” she says.
“I typically keep mine covered for a few days, and then I start putting [on] a little either Vaseline or Triple Biotic [antibiotic ointment] for a few days. It gets red, looks angry for a little bit, and then it heals, depending on how much they took. It’s so minimal.”
Just a couple of hours before sharing her experience in this interview, Tricia had a wide excision on her arm for a possible early melanoma. That’s on top of the 10 or so she’s had over the past couple of months.
“Excisions do hurt a little more. They give you a local anesthetic [during the procedure], and the pain usually starts a few hours later, but nothing that Tylenol can’t handle,” she says.
The most important lesson Tricia has learned in her journey: Catch things early. She does regular skin checks on herself and immediately alerts her dermatologist to anything that concerns her.
“You have to know your own skin,” she says.
Biopsies aren’t just for skin cancer
While skin biopsies are most commonly associated with skin cancer, they are also used to diagnose a variety of other skin conditions and infections.
Sophia Johnson had a shave skin biopsy to confirm an eczema diagnosis. Eczema is a chronic skin condition that causes a dry, itchy rash.
She was given lidocaine, a local anesthetic, to numb the area.
“I didn’t feel anything,” says Sophia, 34, of St. Louis. “It was larger than I thought it would be, though — almost the size of a dime.”
A few hours after the anesthetic wore off, Sophia could feel some mild soreness where the skin was scraped off.
“It was a little tender, like if you were to get a deep scratch,” she says. “If you bump up against it, it’s a little uncomfortable. But otherwise, it was nothing terrible.”
The biopsy was taken on the right side of her lower back. And, since it was a shave biopsy, she didn’t need stitches.
“It did take about 3 weeks for the scab to fall off and to fully heal,” she says. “I do have a scar there now, and I assume that scar will probably always be there. It looks almost like a chicken pox scar, just a little bit larger.”
Sophia received the results of her biopsy a few days later. She is already seeing improvements after starting treatment for eczema.
Visions of a hole-puncher
Precious Walton is still on her diagnostic journey searching for answers about discoloration on her leg.
At first, she thought it was just bruising, but she was referred to a specialist to rule out circulatory issues. An ultrasound later, she was reassured that her veins are fine.
The next stop: a dermatologist. Precious was told she needed a punch biopsy on three different places on her calf.
“In my mind, I’ve got visions of a hole-puncher. I was thinking, ‘This doesn’t sound like fun, but OK, if that’s what it’s going to take to get to the bottom of this,’” says Precious, 45, of Bossier City, Louisiana.
She was numbed for the procedure, and everything went smoothly — although the biopsy was more invasive than she was expecting.
“This wasn’t just a scratch or small test like the doctor explained to me,” she says. “It was the size of a pencil eraser that went down [into her leg].”
On her drive home afterward, she started experiencing a lot of pain.
“My calf was on fire. Whatever was used to numb it was not working anymore,” she says.
She was prescribed antibiotics because, as someone with diabetes, she is at higher risk of infection. But she wasn’t given anything for the pain.
“Usually, I have a pretty high pain threshold,” Precious says. “I had C-sections with both my kids, and this was probably on pace with that. About a 7 or 8 [on the pain scale].”
She called the dermatologist’s office but was told they don’t prescribe pain medications. She eventually connected with her primary care physician, who was able to prescribe three days worth of tramadol. However, she had to choose between taking her anxiety medication or the pain medication, because she was advised against using both at the same time.
“I either got to be anxious or in pain,” she says.
The biopsy results came back inconclusive. Precious was told to come back for further biopsies.
“I’m nervous about it being all in the same area again,” she says. “But I’d rather err on the side of caution than assume it’s nothing. The benefit outweighs the discomfort.”
What does the doctor say?
Patricia Pinto-Garcia, MD, MPH
Senior Medical Editor
Skin biopsies are a necessary, but sometimes painful, medical procedure. They can also be life-saving, as these stories show.
A skin biopsy can help identify skin cancer early, when it’s easier to treat. Biopsies can also confirm or rule out skin conditions. If you have a skin lesion and you’re not sure what’s causing it, a skin biopsy can usually provide a definitive result. This lets you get the right treatment as soon as possible.
Skin biopsies can be painful. All skin biopsies are done with local anesthesia. This means you won’t feel any pain during the procedure. But that anesthesia will wear off in a few hours. Once this happens, you may feel discomfort, especially if you had a deeper biopsy or a wide local excision. It is normal to feel discomfort for the first 72 hours after a biopsy. As your body heals, inflammation will start to resolve and you will feel less discomfort.
It can take several days to weeks for a skin biopsy to heal. It depends on the size of your biopsy and your overall health. Large excisions and biopsies take longer to heal than smaller and superficial ones. Some health conditions, such as diabetes, can also affect how well your body heals wounds. This means it can take longer for your skin to completely heal. You can help your skin heal quickly and safely by avoiding products that irritate your skin, protecting your skin from ultraviolet (UV) rays and following all post-care instructions given by your dermatologist.
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