The Perils of Skin Biopsy

Arch Dermatol. 2007 Oct;143(10):1267-71.
Wound complications following diagnostic skin biopsies in dermatology inpatients.Wahie S, Lawrence CM.
Department of Dermatology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, England. shyamalwahie@hotmail.com

OBJECTIVES: To prospectively determine the wound complication rate for dermatology inpatients undergoing diagnostic skin biopsies during their admission and to determine significant host and procedural risk factors. DESIGN: Prospective assessment, by a single observer, of 100 postdiagnostic skin biopsy wounds in dermatology inpatients. The following data were recorded for each patient: age and sex, presence of comorbidities, smoking status, dermatologic diagnosis, use of immunosuppressive or antibiotic therapy, place of biopsy (whether in the operation theater or in the ward), grade of physician performing biopsy, biopsy site on the body, type of biopsy (whether elliptical incision, punch, shave, or curettage), and wound closure technique. MAIN OUTCOME MEASURE: Wounds were designated as having had no complication or as being complicated by infection, dehiscence, and/or hematoma. SETTING: A dedicated dermatology inpatient ward in a university teaching hospital. RESULTS: Wound complications occurred in 29 (29%) biopsies, 27 (93%) of which were the result of wound infection. Complications occurred significantly more frequently when biopsies were performed below the waist compared with above the waist (P < .02), in the ward compared with the outpatient operating theater (P < .001), in smokers compared with nonsmokers (P < .001), and in those taking corticosteroids compared with those who were not (P < .001). In addition, elliptical incisional biopsies developed complications more frequently when subcutaneous sutures were not used compared with when they had been used (P < .001).
CONCLUSIONS: This study has demonstrated a high rate of wound complications after diagnostic dermatologic surgery on dermatology inpatients with significant host and procedural risk factors. These findings are relevant for other centers with inpatient units where diagnostic biopsies are performed.