A biopsy punch is a circular hollow blade attached to a long, pencil-like handle. It is available as a disposable or a reusable instrument, and it is found in various diameters, ranging from 0.5mm to 10mm. They are used for simple procedures where a skin sample is needed for further study. While some may believe that this instrument is used almost exclusively by dermatologists, the biopsy punch has other purposes.
Diagnosis procedures
Punch biopsies are simple procedures, have almost no complications, and can heal without the need of suturing. Sometimes, two tissue samples are needed to obtain a better diagnosis. For example, in the split-punch biopsy technique, the punch is advanced into the papillary dermis and is then reintroduced into the subcutis to obtain a bisected tissue split.1 Biopsy punches are also used in nail plates and nail beds. For these, a larger size punch is used to remove the overlying nail plate. Then, a smaller punch is used to remove a sample of the bed.
Therapeutic uses
The Biopsy Punch not only provides samples of skin tissue, it can also be used to remove embedded hair follicles, callous formations, tiny cysts or nodules. They are also used for hematoma drainage, and to enhance wound healing. For this technique, punch holes of 2mm or 2.5mm are made in the floor of a granulating ulcer, under 5mm from each other. Then, previously harvested grafts, taken with a 3mm punch from the patient’s buttocks or thighs, are pushed into the recipient holes to promote healing.
Cosmetic techniques
Although it is preferable to avoid doing biopsies in sensitive areas, like the face, the biopsy punch can be used for cosmetic purposes. In acne scar treatment, for example, specifically in the punch incision and elevation technique, if the depressed scar has a normal surface texture, it is incised up to the subcutaneous tissue and elevated to the level of the surrounding skin. Punches are sometimes used for tattoo removal. Small tattoos or remnants still remaining after laser treatments may be removed by a biopsy punch and then stitched by a single suture. In liposuction, a punch is used to make a hole where the suction cannula will be inserted into.
A simple skin biopsy punch has many applications, not exclusive to dermatology. It is used to confirm a diagnosis and to remove undesirable lesions, such as callouses or corns, and it is also very useful for grafting chronic ulcers. Samples taken from other areas of the body can also help in providing a definite treatment for a series of conditions.2 The biopsy punch is used to treat and diagnose many medical and surgical conditions beyond dermatology. It is also useful in Gynecological tests.
Colposcopy
A colposcopy is a close examination of the cervix, vagina and vulva to find any signs of disease. A colposcope is usually needed for this; a long, thin tube with a magnifying lens and a light to visually inspect the area for any abnormality.3 Sometimes, a biopsy of the cervix may be required to obtain samples for a more detailed examination. This is where the cervical punch biopsy comes into play. Biopsy forceps are inserted through the speculum and used to extract tiny specimens, smaller than a grain of rice, from selected areas of the cervix.
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References
1Hurkudli, Deepak S. (2015 Mar-April). Novel Uses of Skin Biopsy Punches in Dermatosurgery.
2Zuber, Thomas J. MD. (2012, June). Skin Biopsy Techniques: When and How to Perform Punch Biopsy.
3Colposcopy and Cervical Punch Biopsy. (2015, January).
