If you’re heading in to the dermatology office for a procedure and don’t know what to anticipate, this information is for you! Here are some of the most common procedures that are performed in a dermatology clinic and what to expect.

A skin biopsy is a medical procedure done to help diagnose a skin condition when it is not possible to determine what it is based solely on an exam. This type of procedure is necessary to diagnose skin cancer. Biopsies can also help determine the underlying cause of a rash (eczema, psoriasis, etc). During a skin biopsy, your dermatology provider will:

1. Cleanse and numb a small area of the skin. Your dermatology provider will use an alcohol wipe to clean the skin, then give an injection to numb the area. You may feel some mild burning or stinging while the numbing medication is injected.
2. Remove some (or all) of the skin that needs a closer evaluation. There are different techniques used to remove a skin tissue sample, depending on what the dermatology provider suspects may be going on and the size and location of the lesion. Here are the two most common biopsy procedures done in the dermatology office:
   • Shave biopsy: Using a tool that looks like a razor blade, the dermatology provider will shave off a thin sample of the topmost layers of the skin.
   • Punch biopsy: Using a tube-shaped tool that looks and works similar to a cookie cutter, the dermatology provider can remove a small column-like skin sample that goes into the deeper layers of the skin. This type of biopsy usually requires stitches.
3. Dress the wound. The dermatology provider and staff will help treat the wound created at the biopsy site. First, they will apply pressure and/or medication to help stop the bleeding. If necessary, the dermatology provider will close the wound with stitches. Antibiotic ointment or pure petrolatum will be applied to the wound prior to applying a bandage and/or pressure dressing.
4. Provide wound care instructions. You will be provided information regarding wound care for the biopsy site, and when to return for stitch removal if needed.
5. Send the removed skin tissue to a dermatopathologist. The sample is sent to a physician called a dermatopathologist, who will examine the skin tissue under a microscope. They will write a report about the diagnosis based on their medical findings, and will send the results back to your dermatology clinic, usually within 7-10 days.
6. Contact you with the results: After your dermatology provider has reviewed the dermatopathology report, they will call you to go over the results and give recommendations if any further treatment is needed.

This medical procedure involves freezing the affected area of skin with an extremely cold spray called liquid nitrogen. The liquid nitrogen causes local destruction to the treated skin. This is a common treatment for precancerous lesions like actinic keratoses or benign lesions like warts, skin tags, or seborrheic keratoses. During cryotherapy, your dermatology provider will:

1. Identify the local areas needing treatment. If the affected area to be treated is near your eye, the eye will be covered for protection.
2. Apply liquid nitrogen. This extremely cold substance is most commonly applied with a spray canister. Alternatively, a cotton-tipped applicator can be used for areas that are very close to the eye. Liquid nitrogen is applied to the lesion(s) 1-2 times during each treatment to cause an acceptable amount of local skin irritation.
3. Provide care instructions: Areas treated with liquid nitrogen will likely become red, swollen, sensitive, and sometimes even blister as part of the natural inflammatory process. You will receive care instructions regarding gentle cleansers and moisturizers to use while the skin is healing. Skin irritation can be expected for up to 4-6 weeks. Some lesions require more than 1 treatment.

A culture is a common, minimally invasive test done to test for infection involving the skin or nails. During a culture, you can anticipate the following:

• Bacterial culture: If your dermatology provider suspects that you may have a bacterial colonization causing stubborn acne-like breakouts around the nose and mouth, they will roll a swab similar to a long Q-tip inside your nostrils. This kind of bacterial swab can also be used to check drainage from a boil or pustule for bacteria. The collected material on the swab is sent for lab testing, which takes about 7-10 days. Your dermatology provider is then sent a lab report of any type of bacterial growth present and what antibiotic therapy would be appropriate if needed. Your dermatology provider will then contact you to let you know if any treatment is necessary.
• Viral culture: If there is suspicion for a viral infection causing a blistering rash, your dermatology provider will drain one of intact blisters using a tiny blade and allow the liquid to collect on a Q-tip-like swab. The collected liquid on the swab is sent to a lab to be processed over the next 7-10 days. Your dermatology provider is then sent a report of the type of virus present, if any, and your provider in turn will contact you to let you know if further treatment is needed.

Fungal culture: Fungus grows very slowly, so these kinds of culture take longer- usually 30 days. These types of cultures check for presence and type of fungus, yeast, or mold. If there is suspicion for fungal infection of the nails, a nail clipping is taken in the office and sent to a lab for further processing. You will be contacted by your dermatology provider with your results approximately 1 month after the nail clipping is sent, and if further treatment is needed, they will let you know at that time.

Hopefully this removes some of the unknowns that come with getting ready for a dermatology visit. If you have more questions about dermatology procedures, feel free to contact us with any questions or set up an appointment! Click here to book your appointment now!