Shave Biopsy

Consent Form

Shave Biopsy Consent Form

Equipment List

Nitrile exam gloves (1 pair)

Toothed pickup (1)

DermaBlade (1)

ChloraPrep 3 ml stick (1)

Sterile 4x4 gauze (10)

Sterile 2x2 gauze (about as many as expected biopsies)

Medical paper tape (1 roll)

1% or 2% lidocaine (with 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)

DrySol (Aluminum chloride) (1)

Sterile cotton tipped applicators (CTA) (10)

Petroleum ointment (1 packet)

Procedure Note


The procedure was explained in detail and informed consent was obtained from the patient.  The area was prepped in a sterile fashion, and infiltrated with _ ml of _% lidocaine with_ epinephrine for local anesthesia.  Forceps were used to elevate the lesion and a shave biopsy was performed with DermaBlade.  The specimen was placed in a specimen jar and sent for analysis.  DrySol solution was used for hemostasis. Petroleum ointment and a bandage were applied.  EBL was less than 1 ml.  Good hemostasis.  There were no complications.  Wound care and post-procedure warning signs were discussed.  Patient voiced understanding.