(Video Poster 15) Snip Biopsy over Punch Biopsy for Vulvar Dermatoses

Objectives: The snip biopsy, over the punch biopsy, is recommended by vulvar dermatology specialists to collect a more shallow, broad-based sample with a greater surface area for analysis in the investigation of vulvar dermatoses. In this video, we present the ideal technique for office-based vulvar snip biopsy.

Methods: The materials for this biopsy are easily accessible in the healthcare environment: a chlorhexidine or iodine-based cleansing agent, sterile gloves, 1% or 2% lidocaine, a small-gauge needle with a 5cc or 10cc syringe, a needle driver, Mayo or Metzenbaum scissors, a 4-0 SH monofilament suture, gauze, aluminum chloride, and a formalin container. Once the materials are obtained and the patient is positioned, the concerning area should be examined for the best biopsy location. Following this, the intended biopsy site can be marked and then cleansed with a prep solution. The area can then be injected with 2-4cc of lidocaine, which should be allowed to sit for 10 minutes. A stitch should be placed through the epidermis at the center of the intended biopsy site, and the ends of the stitch elevated to tent the skin. Scissors can then be used to excise the tented epidermis in a long, narrow strip. Pressure with gauze or aluminum chloride can be used on the resulting wound for hemostasis, which can usually be easily achieved with these methods. Very rarely, a stitch may be required. The biopsy can be placed in a formalin solution and sent to pathology. The patient should be instructed to apply petroleum jelly to the area 2-3 times per day for several days to assist the healing process. One should aim for an intended biopsy size of 2mm wide by 6mm long, in comparison to the standard 4mm punch biopsy, which will result in a much greater surface area of tissue for pathologic examination. It may be helpful to become familiar with a knowledgeable pathologist at your institution to examine the specimen. Direct communication and correlation with the clinical presentation may aid in making a correct diagnosis.

Clinical Relevance: This video demonstrates an updated perspective on biopsy for diagnosis of vulvar dermatoses. This technique requires materials readily available in the gynecology office, and may be performed with a similar timespan and ease to a punch biopsy, while providing a greater surface area and less trauma. Office vulvar biopsy is a helpful tool for the diagnosis and correct treatment of vulvar dermatoses, and by optimizing technique in this procedure we can improve the likelihood of successful pathologic diagnosis.