By Maxine Lipner 

Published on September 22, 2023

 Medically reviewed by William Truswell, MD

If you have a suspicious skin lesion, a healthcare provider may recommend undergoing a punch biopsy to evaluate the cells for precancer or cancer. It may also be done to determine skin disorders, such as psoriasis, eczema, warts, or a bacterial or fungal infection.

A punch biopsy involves removing a sample of all of the layers of skin in an area. Before the sample is taken, the area is thoroughly numbed.1

Your healthcare provider will use a round tool akin to a cookie cutter and rotate it to cut through the layers of numbed skin. The sample is removed and sent to the lab for examination. The healthcare provider then stitches up the wound and allows it to heal.2

American Cancer Society. Punch biopsy.

As part of this article, you will learn when you may need a punch biopsy, what this feels like, what the procedure entails, and what you can expect regarding healing.

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When a Provider Orders a Punch Biopsy 

A punch biopsy is the most common type of skin biopsy used if a skin lesion is suspected of being cancerous.1 A healthcare provider might also order one to diagnose precancerous skin conditions, noncancerous skin tumors, or other noncancerous skin conditions.

In a punch biopsy, a cylinder of tissue is removed and evaluated. This provides a sample of all skin layers (epidermis, dermis, and subcutaneous tissue).

Cervical Punch Biopsy

A punch biopsy might also be performed on the cervix, the part of the uterus that opens into the vagina. It is one of the biopsy techniques that can be done in a colposcopy procedure. Colposcopy with biopsy is used to help detect cancerous or precancerous cells if you've had an abnormal Pap smear. It also may be used in conditions like genital warts, noncancerous polyps, or cervical inflammation.3

For a cervical biopsy, usually done at the provider's office, you'll need to undress as you would for a gynecological exam. A speculum will be used to keep the walls of the vagina apart to access the cervix, view it with a colposcope, and remove small tissue samples to be analyzed in the lab.

The cervical punch biopsy is usually done with no numbing. You may feel stinging from the cleaning solution used. You might also feel a momentary sharp pinch or cramp when the sample is taken. Remaining relaxed and breathing regularly can help to relieve this somewhat. Afterward, you may also have a little vaginal bleeding and cramping.3

Does the Punch Biopsy Tool Cause Pain?

You will receive an injection of local anesthesia (such as lidocaine) for a skin punch biopsy. The area will be numb during the procedure itself. Without this anesthesia, it would hurt. The injection will likely cause brief stinging.

Afterward, some people may experience some temporary sensitivity or tenderness in the area. To keep any soreness to a minimum, your healthcare provider may suggest taking over-the-counter (OTC) pain medication.4

Step-by-Step Walkthrough 

Getting a punch biopsy is fairly straightforward and can be done in a healthcare provider's office in as little as 15 minutes. Here is what to expect.

First, the healthcare provider will clean the area with an antiseptic to reduce the chances of infection. They will inject a small amount of local anesthetic into the skin. It will sting for a second but will numb the area for the procedure.

Once the anesthetic takes hold, your healthcare provider will pull the skin taut using one hand. Then, they will place the circular punch tool over the area and push it down using a twisting motion.

Once the tool has penetrated all of the layers of skin, scissors may be used to help free up the sample, and a needle used to help remove it.

The wound is then closed. It usually requires only one suture. The healthcare provider bandages the area, and you can leave.4

Healing and Scarring From Punch Biopsy 

Depending on the type of suture, you may need to return to have it removed in a few days. If the biopsy was done on your face (the most common site), you'll return in five days for suture removal to prevent scarring.

After the procedure, it can take a little time for the wound to heal. During this period, it's important to keep the area moist with the aid of ointment. This will help speed healing and prevent scarring.

It's also important to keep an eye out for infection. Some signs to watch for include the following:5

  • Redness that spreads

  • Discharge from the wound

  • Fever

  • Chills

  • Extreme tenderness

In most cases, you can expect the punch biopsy wound to heal in just a couple of weeks, but this depends on the site of the biopsy and how deep this was, and your overall health.

Pathology Findings From Punch Biopsy 

The biopsy sample will be sent to a laboratory where it will be analyzed and a pathology report created. This report will explain the types of cells found and whether any of these are abnormal.

Keep in mind that an abnormal result does not necessarily mean that cancerous cells were found. It can mean a range of things, including:4

  • You have a classic mole, which is categorized as an intradermal benign nevus.

  • There's an infection in the area.

  • You have eczema, psoriasis, or some other skin condition.

  • They found precancerous cells from a skin condition such as lentigo maligna or actinic keratosis.

  • Some cancerous cells were found in the sample.

With the pathology findings in hand, it will then be up to your healthcare provider to chart the best course of action.

Summary

A punch biopsy may be recommended to determine the cause of a suspicious skin lesion. This type of biopsy enables your healthcare provider to evaluate all skin layers to see if cancer, precancer, or other skin conditions are present.

The procedure is done under local anesthetic (such as lidocaine) and is painless, although it may cause some soreness afterward. A punch biopsy is usually done on an outpatient basis and only takes about 15 minutes. The sample will then be sent out to be evaluated.