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ProceduralDiagnosticOPCS S14.x

Shave biopsy technique

Tangential biopsy · scoop excision · saucerisation

A shave biopsy removes the lesion at the level of the epidermis or upper dermis using a flexible Razor / Dermablade or scalpel held tangentially. It is the standard technique for benign protruding lesions, seborrhoeic keratoses, fibroepithelial polyps, suspected superficial BCC, actinic keratosis, intradermal naevi and selected keratoacanthomas. It is NOT recommended for pigmented lesions where invasive melanoma is suspected, since transected depth may compromise Breslow measurement.

CurrentLast reviewed 16 May 2026

Indications

  • Seborrhoeic keratosis (cosmetic / diagnostic).
  • Fibroepithelial polyp / skin tag (acrochordon).
  • Superficial BCC suspected — diagnostic.
  • Bowen disease / actinic keratosis — diagnostic.
  • Intradermal melanocytic naevus (cosmetic; counsel about pigment / hair return).
  • Verruca vulgaris.
  • Pyogenic granuloma.
  • Sebaceous hyperplasia.
  • Dermatofibroma (with caveat re depth).

Avoid:

  • Pigmented lesions where melanoma is suspected — full excisional biopsy preferred (NICE NG14).
  • Subcutaneous / deep dermal lesions — punch or excisional.
  • High-risk anatomical site (eyelid, vermilion, alar rim) where saucer defect would distort.

Technique

  1. Pre-procedure: explain, consent, photograph; document size, location, dermoscopy if relevant.
  2. Local anaesthesia: lidocaine 1% with adrenaline; injection into superficial dermis to raise a wheal that elevates the lesion.
  3. Antiseptic prep: chlorhexidine or povidone-iodine.
  4. Blade choice:
    • Flexible double-edged razor blade (Personna / Bard-Parker) — most controlled depth.
    • Dermablade — pre-curved, single-use.
    • #15 scalpel held tangentially — for thinner / more delicate work.
  5. Stretch skin with non-dominant hand.
  6. Shave: smooth horizontal sawing motion at appropriate depth:
    • Superficial shave: above papillary dermis (sebK, skin tag, intradermal naevus).
    • Deep saucerisation: into upper reticular dermis (suspected superficial BCC, AK, KA).
  7. Specimen handling: gentle with skin hook; avoid crush; orientate if relevant.
  8. Haemostasis:
    • Pressure with gauze.
    • Aluminium chloride 20-35% (Drysol) — chemical haemostasis.
    • Ferric sulphate (Monsel) — discolouration of underlying skin (avoid biopsies needing further investigation).
    • Electrocautery (light hyfrecation).
  9. Healing by secondary intention — most shave biopsies; complete in 7-14 days.

Pitfalls and limitations

  • Inadequate depth — particularly for keratoacanthoma, where deep wedge or excisional preferred to characterise architecture.
  • Transected base in melanocytic lesion — compromises Breslow measurement; never shave suspected melanoma.
  • Hypopigmented scar — particularly in Fitzpatrick III-VI.
  • Hypertrophic / keloid scar — shoulder, chest, anterior shins.
  • Pigment / hair return after intradermal naevus shave — counsel.
  • Inadequate sampling for diagnosis in heterogeneous lesions — consider multiple punches or excisional.

Aftercare

  • Soft paraffin / petroleum jelly twice daily until re-epithelialised.
  • Non-stick dressing for 24-48 hours.
  • Healing 7-14 days; oedematous edges flatten over weeks.
  • Sun protection 3 months to minimise hyperpigmentation.
  • Counsel about cosmesis: flat scar, may be hypopigmented; superior to elliptical excision for benign protruding lesions.

References

  1. Pickett H. Shave and punch biopsy for skin lesions. Am Fam Physician. 2011;84:995-1002.
  2. Zhang RZ et al. Saucerisation biopsy for the diagnosis of pigmented lesions: cautions and pitfalls. J Dermatol. 2012;39:743-748.
  3. British Association of Dermatologists. Staffing and Facilities Guidance for Skin Surgery Dermatology Services. London: BAD; version 4, updated June 2014; accessed 18 May 2026.
  4. NICE NG14. Melanoma: assessment and management. London: NICE; 2015 (last updated 27 July 2022).

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