
Overview
This module describes how to perform a shave or saucerisation biopsy to sample the epidermis and superficial dermis. In a shave biopsy, a razor blade removes a superficial sample. In a saucerisation biopsy, a scalpel is used in a circular motion to cut a slightly conical disk of skin.
Indications
Seborrheic keratoses
Verrucous lesions
Molluscum contagiosum
Non-melanoma cutaneous carcinomas
Pedunculated lesions and skin tags
Sites with a risk of poor cosmesis for fusiform excision, or with a risk of hypertrophic scarring
Contraindications
Most pigmented lesions
Hairy naevi
Dermatoses involving deeper layers of the skin
Suspected sclerosing basal cell carcinoma (rather punch or saucerise)
Patient information and consent
Always verify your patient’s identity and obtain informed consent before proceeding.
How do I explain this procedure?
“I need to take a sample of your skin lesion to find out what it is. The method is called a shave/saucerisation biopsy. I will use a small blade to shave off the upper layer of the skin. It will not need stitches.”
What can my patient expect?
“I will give you an injection so that you will not feel me taking the sample. You may feel tugging and working in the area, but it will not be painful. The laboratory test may take a few days
or longer
Histology often takes 6 weeks for results. If urgent, call the pathologist directly to discuss and expedite.
, and we will then contact you about your diagnosis.”
What is my patient’s role?
“Let me know if you have any allergies or a bleeding tendency, or use blood thinners. Fearing blood or needles is normal, but tell me if you have fainted from it. Keep still while I take the sample. Afterwards, keep the plaster on for at least a day.”
Preparation
Prepare a trolley with equipment.

Documentation
Patient notes
Patient labels
Histology forms
Equipment
Sterile gloves
Alcohol-based hand rub
- Sharps containerSharps container
If a sharps container is not within arm's length, use a kidney dish or other hard container to temporarily hold used sharps and to carry them to the sharps container for disposal.
Two alcohol swabs
For saucerisation: a swab soaked in
skin disinfectantskin disinfectantCommonly used preparations include 0.5-2% chlorhexidine in 70% alcohol (Steriprep), or 10% povidone iodine. There is no consensus on the superiority of one agent above another. Caution: chlorhexidine solutions may be associated with burns and skin breakdown in infants < 2 months old.
A 3 ml syringe
Gauze
Lignocaine
An aspiration needle (preferably blunt fill) and injection needle
For saucerisation: no 15 scalpel blade
For shave biopsy: double-edged razor blade
- Silver nitrate stickSilver nitrate stick
Ideally, have cautery available, Monsel's solution (ferric subsulfate) and aluminium chloride. Monsel's solution can rarely cause tattooing. Aluminium chloride slows wound healing. Silver nitrate can also cause tattooing.
or other haemostatic agents
A gauze dressing and transparent film dressing
Specimen jar and formalin
Site and Positioning
The patient should be positioned reclining or supine with the lesion within easy reach.
Procedure
Follow medical asepsis with non-sterile gloves.
Perform hand hygiene. Don non-sterile gloves.
Clean the area with an alcohol swab (chlorhexidine/povidone iodine for saucerisation)
Pinch up the skin with your non-dominant hand and inject lignocaine under the base of the lesion.
For shaving: Steady the skin with your non-dominant hand and use the scalpel blade, held parallel to the skin, to shave off the lesion to the level of the dermis.
For saucerisation: hold the blade at a 45° angle and use a circular motion to cut away a conical disk of tissue.
Use direct pressure and the silver nitrate stick to stop bleeding.
Apply a gauze pad and transparent film dressing.
Dispose of medical waste safely.
Label a specimen jar of formalin, and send the specimen in it to the laboratory with a histology form.
Record completion of the procedure in patient notes.
Risks
Local pain or excessive bleeding at the site
Infection at the site
Scarring
Sharps injury to healthcare personnel
Vasovagal response (fainting)
References
Skin Biopsy Techniques: When and How to Perform Shave and Excisional Biopsy. Consultant. 2012(52):7. Available from: https://www.consultant360.com/article/skin-biopsy-techniques-when-and-how-perform-shave-and-excisional-biopsy
DiBaise M. Dermatologic Procedures. In: Essential Clinical Procedures, Third Edition. Philadelphia: Elsevier; 2013.