Vulvar Biopsy
A number of techniques have been reported that use vulvar biopsy. Regardless of the technique selected, the vulvar skin, unlike the cervix, has many pain receptors, and biopsy specimens cannot be taken without the aid of local anesthesia. Injection of 1% lidocaine with a 27-gauge needle will create sufficient anesthesia to permit the biopsy to be done painlessly. The injection discomfort itself may be significantly diminished by having the patient apply EMLA cream 30 minutes before the anticipated injection.
Dermatologists prefer to use a dermal punch and scissors for biopsies. The major advantage of the punch relates to the fact that it creates a flat disc sample that is easy for the pathologist to orient. This type of sample therefore is unlikely to result in a tangential tissue section.
After the creation of adequate anesthesia (objectively tested by squeezing the site with toothed forceps), the skin is flattened with one hand, and the sharp punch is applied and twisted back and forth two or three times until a full-thickness cut has been made through the skin (Fig. 65–1A, B). Next, with a fine forceps, the skin disc is elevated and its base cut away from surrounding fat and connective tissue (Fig. 65–2A through C). The sample is placed into fixative and transported to the pathology laboratory. The biopsy site is compressed with a sterile sponge and then is closed with two or three interrupted Vicryl sutures.
The dermal punch may be omitted by elevating the piece of skin to be biopsied and then simply cutting it off at the base with scissors or a knife (Fig. 65–3). As with the dermal punch technique, this requires the placement of sutures for hemostasis.
