A novel simple biopsy-site identification tool

In patients with suspected skin cancer, preoperative biopsies are usually performed. It is important to confirm the histopathology and extent of the tumor before optimal treatment plans can be established. In case of ill-defined clinical borders, it is necessary to perform multiple biopsies for mapping the lesion. Especially when multiple biopsies are taken, it is important to carefully document the biopsy sites for identification afterward. This can be difficult, particularly because several weeks might pass before surgery is planned and the biopsy sites are fully healed and poorly visible if scarring is minimal. Photographic imaging is a helpful tool to identify biopsy sites. However, especially on the scalp it is hard to identify biopsy sites because of hairs covering them and the lack of distinct anatomic landmarks. Also, when multiple biopsies are taken it is sometimes challenging to reidentify every biopsy site. This can result in dislocation of the lesion, with possible positive surgical margins, unnecessary excision of healthy skin, and even surgery on the wrong site. Incorrect preoperative biopsy-site identification is found in up to 4.4% of Mohs micrographic surgery lesions.1McGinness J.L. Goldstein G. The value of preoperative biopsy-site photography for identifying cutaneous lesions.Dermatol Surg. 2010; 36: 194-197Crossref PubMed Scopus (43) Google Scholar Furthermore, 14% of malpractice claims among surgeons performing Mohs micrographic surgery are due to wrong-site operations.2Perlis C.S. Campbell R.M. Perlis R.H. et al.Incidence of and risk factors for medical malpractice lawsuits among Mohs surgeons.Dermatol Surg. 2006; 32: 79-83Crossref PubMed Google Scholar We present a simple solution for this clinical dilemma on hair-bearing scalp. An overview picture including anatomic landmarks with (multiple) markers of the biopsy sites before biopsies are taken can be a useful tool. In this way, detailed preoperative biopsy-site identification is performed and therefore prevents mistakes in identifying biopsy location (Fig 1). In this case, we used disposable cotton swab sticks and stickers.