Incisional and Excisinal Skin Biopsy


Incisional Biopsy Consent Form

Excisional Biopsy Consent Form


Nitrile Exam Gloves (1 pair)

Sterile Gloves (1 pair)

15 Blade Disposable Scalpel (1)

Iris Scissors, Straight (1 pair)

Needle Driver (1 pair)

Toothed Pickup (1)

Suture: Assorted (if specific suture not requested by provider)

3-0 Vicryl (1) - absorbable for deep or layered repair

4-0 Ethilon (1) - for skin closure

Sterile Medium Drape (1)

ChloraPrep 3 mL stick (1)

Alcohol Swabs (4)

Sterile 4x4 gauze (5)

1% or 2% lidocaine:  If fingers, toes, penis, or nose - then without epinephrine.  Otherwise it is ok to have epinephrine.   (1 vial with minimum 20 mL remaining)

10 ml syringe (1)

18 gauge 1.5 inch needle (1)

27 gauge 1.25 inch needle (1)

Exam-room sheet (1 sheet, when necessary due to location of area to be excised)

Chux Pads (1)

Formalin cups (as many cups as biopsy specimens)

Paper Medical Tape (1 roll)

Sterile 2x2 gauze (5)

Procedure Note


The procedure was explained in detail and informed consent was obtained from the patient.  The area was prepped and draped in a sterile fashion, and infiltrated with _ ml of _% lidocaine with_ epinephrine for local anesthesia.  

An elliptical _cision was performed, and the specimen was placed in specimen jar and sent for analysis.

Closure was performed with _ suture material.  Petroleum ointment and a bandage applied.  EBL less than 1 milliliters.  Good hemostasis.  There were no complications.  Patient instructed to follow up for fever, erythema, swelling, pain, or purulent discharge from the wound.  The patient voiced understanding.  Suture removal in _ days.

Time Until Suture Removal

Duration of time to leave sutures