Vulvar Biopsy

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SAMPLE EXCERPT
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PRE-PROCEDURE
INDICATIONS
  • Pigmented lesions
  • Vulvar ulceration of uncertain origin or a nonhealing ulcer
  • White epithelium (skin that turns white after the application of 5% acetic acid)
  • Leukoplakia
  • Presumed condylomata that do not readily respond to conventional therapy
  • Any skin abnormality that requires definitive diagnosis
CONTRAINDICATIONS

Absolute

  • Allergy to local anesthetic/preservatives

Relative

  • Bleeding diathesis
  • Recent (<3 weeks) chemical destruction attempts on the lesion
EQUIPMENT
  • A 3-mm Keyes punch biopsy, a cervical punch biopsy forceps or sharp tissue scissors, or a No. 15 blade for elevated or non–hair-bearing areas ("shave biopsy")
  • No. 15 scalpel blade for excision
  • 1% lidocaine with or without epinephrine
  • ½-inch, 30-gauge needles
  • 1- to 5-mL syringe
  • Nonsterile gloves (sterile gloves needed if placing sutures)
  • Formalin containers
  • Iris scissors
  • Pickups
  • Povidone-iodine or alcohol swabs
  • Monsel's solution or aluminum chloride solution
  • Small cotton-tipped applicators
  • Antibiotic ointment
ANATOMY

Skin

  • Skin tension lines
    • Figure 2 shows basic vulvar anatomy and the lines of skin tension.
    • Skin tension lines are important when excisional or punch biopsies of the vulva are considered. With the index finger and thumb of the nondominant hand, the skin should be stretched perpendicular to the tension lines, so that the excision margins form an ellipse after release.

PROCEDURE
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The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures

POST-PROCEDURE
CARE
  • Apply a small amount of antibacterial ointment to the biopsy site.
  • Instruct the patient to do the following after the procedure:
    • Wash the area twice a day with soap and water.
    • Apply antibiotic ointment after each cleansing.
    • Use acetaminophen or ibuprofen for discomfort (unless contraindicated).
    • Take sitz baths as needed for discomfort if extensive biopsies were performed.
    • Use ice packs as needed.
    • For more recalcitrant pain, use over-the-counter benzocaine gel as needed.
    • Call if there is persistent pain, redness, or swelling.
    • Avoid intercourse until the discomfort is gone (usually 3-5 days).
    • Arrange a follow-up appointment or phone call to discuss biopsy results.
COMPLICATIONS

The following complications are extremely rare:

  • Infection
  • Bleeding, hematoma, ecchymosis
  • Hypopigmentation
  • Pain
  • Scar
  • Recurrence
  • Hyperpigmentation from Monsel's solution (usually temporary)
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