QDo you biopsy any differently when sampling the genital area?
When I biopsy the genital area, I like to use a modified shave technique, which makes it easier for me to obtain an adequate sample from a convex surface.
To make the patient more comfortable, I offer a topical anesthetic such as topical lidocaine, which I ask them to apply approximately 30 minutes prior to their appointment. Similar to other skin biopsies, I inject 1% lidocaine with epinephrine, but I give myself extra time to allow a full 10 to 15 minutes for vasoconstriction. I utilize a 4-0 Vicryl suture to pull up a small section of skin, then I employ sharp scissors at the base of the tented skin to collect the sample. The biopsy is roughly the same size a typical shave.
Most often, topical aluminum chloride suffices for hemostasis, but if a suture is indicated, I use the same Vicryl suture in an interrupted fashion to close the defect. Since the suture is absorbable, the patient does not necessarily need to return for removal, and it is a softer suture, which is less likely to cause irritation on the genital skin.