UC Davis
Dermatology Online Journal
Title
The tangential punch biopsy
Permalink
https://escholarship.org/uc/item/1g60q188
Journal
Dermatology Online Journal, 25(12)
Authors
Breslavets, Maksym
Lapa, Tatiana
Publication Date
2019
DOI
10.5070/D32512046730
Copyright Information
Copyright 2019 by the author(s).This work is made available under the terms of a Creative
Commons Attribution-NonCommercial-NoDerivatives License, available at
https://creativecommons.org/licenses/by-nc-nd/4.0/
eScholarship.org Powered by the California Digital Library
University of California
Volume 25 Number 12| December 2019|
Dermatology Online Journal || Letter 25(12):14
The tangential punch biopsy
Maksym Breslavets MD PhD FRCPC FAAD, Tatiana Lapa MD
Affiliations: Center for Medical and Surgical Dermatology, 220 Dundas Street, West Unit 200 Whitby, Ontario, Canada, Tel: 905-
493-5700, Fax: 905-493-1170
Corresponding Author: Tatiana Lapa MD, Center for Medical and Surgical Dermatology, 220 Dundas Street, West Unit 200 Whitby, ON
L1N 8M7, Canada, Tel: 905-493-5700, Fax: 905-493-1170, Email: fortanyalapa@gmail.com
is left to heal by secondary intention and hemostasis
Abstract is achieved with a topical hemostatic agent. The
Dermatologists around the world widely utilize skin tangential punch biopsy allows for biopsies at hard-
biopsies, which can be performed using shave, to-reach areas, for example the concha of the ear. We
punch, incisional, or excisional techniques [1]. The are using a disposable punch instrument, which is
punch biopsy allows a dermatologist to obtain a full- tangentially inserted into the skin at an acute angle
thickness skin sample. The post-biopsy wound heals
and rotated in an arc-like movement, creating semi-
by primary closure or second intention [2]. Some
suspicious lesions may be located at the body parts spherical defect at different depths (Figures 1, 2). It
that are difficult to access. can also be pushed horizontally into the skin in the
same fashion to obtain a larger sample. The depth of
the required sample depends on the angle of
insertion and the punch diameter. Another
advantage of the tangential punch biopsy is the
ability to evaluate deep layers of the skin by
modifying the trajectory of the punch tool
movement.
In all abovementioned techniques, appropriate
documentation is essential. Prior to any biopsy,
patients should be educated on the associated risks,
Figure 1. The tangential punch biopsy of the orange peel.
Keywords: tangential punch biopsy, punch biopsy
We would like to introduce the tangential punch
biopsy of the skin, the technique that has been
initiated at our clinic and in use successfully for more
than three years. It is an extended form of the
existing punch biopsy modality. This technique can
be used to excise small skin lesions, therein
obtaining a sample with a smaller surface wound
than a regular shave biopsy. The post-biopsy wound Figure 2. The tangential punch biopsy technique.
-1-
Volume 25 Number 12| December 2019|
Dermatology Online Journal || Letter 25(12):14
including bleeding, infection, and scarring, and Potential conflicts of interest
patient consent should be obtained and The authors declare no conflicts of interests.
documented in the medical record [3].
References
1. Zuber TJ. Punch biopsy of the skin. Am Fam Physician. randomized trial. Arch Dermatol. 2005;141:1093-1099. [PMID:
2002;65:1155-8, 1161-2, 1164. [PMID: 11925094]. 16172305].
2. Christenson LJ, Phillips PK, Weaver AL, Otley CC. Primary closure 3. Kircik LH. A Closer Look at the New Biopsy Codes. Cutis.
versus second-intention treatment of skin punch biopsy sites: a 2019;103:122-123. [PMID: 31039228].
-2-
