Punch Biopsy Experience/Advice?

[Deleted]

We thought we were in the clear with DS.. after 116 days, his rash disappeared, and he had two days of beautiful, clear skin, but he's back to full body hives again. We thankfully didn't cancel his dermatology appointment, so in a couple weeks he'll get a punch biopsy to see if they can figure out the cause. 

I.. can't google stuff like this because I'm squeamish. Instructions we have are to put emla cream on a couple of spots that they can potentially biopsy about an hour before, and ice 20 minutes before. Is this something I should be asking his PCP about a dose of Ativan or other antianxiety medication for?

Can anyone give me a not so graphic description of what to expect? Any areas that might be easier/less pain/quicker healing? Dermatologist suggested a few places that would be less likely to have a visible scar, but I doubt he's going to let her have a go at his butt or inner thigh. The rash is usually most visible on areas that are hidden by his school uniform (shorts/polo), so there's plenty of real estate to chose from. 

[STP]

I had four of them done on my breasts a couple years ago.

Honestly...it's going to suck and all you can do is get through it. Truly.

Prepare him as best you can, and just keep breathing through the whole thing. Give yourselves time to be upset after.

I'm sorry.

[Rusty Red]

I have lost count of both punch and shave with my skin cancer history. I have to second STP. It's keep breathing and push through it. He should have lidocaine, which isn't the greatest fun but at least mitigates the biopsy ouch; though there will be an ouch with the lidocaine too. I'm really sorry you both have to deal with this.

[jnetx]

I had one done when I was in third grade. This may not be the most reliable account, but I don't remember it hurting a lot. I dreaded it and was scared but then it was over before I knew it. I don't know what kind of pain management I had, but I know it was over before I realized it had happened. I just had one done and it was on my outer thigh/hip area. Those who have had it done as adults probably can give you a better idea of what to expect, but it was not as bad as I was expecting as a child.

[betts]

I had one and they numbed me with something in a needle which didn't hurt at all. I didn't feel anything with the biopsy. They stitched it and it barely hurt at all. Stitches removed a week later.

[lucilleaustero]

I had both punch and shave biopsies. Let it breathe afterwards. I was a bit sore after the shave biopsy, but the punch only really stung for a day.

[gingy]

Mar 7, 2023 15:51:37 GMT -6 betts said:

I had one and they numbed me with something in a needle which didn't hurt at all. I didn't feel anything with the biopsy. They stitched it and it barely hurt at all. Stitches removed a week later.

Same.

I get really lightheaded with needles, though, and honestly wish I'd asked for something for anxiety. My derm had me lie down so I couldn't see anything and even slightly inverted the table at one point when I started to get dizzy. The biopsy itself and healing were NBD. 

[wedding]

Mar 7, 2023 15:51:37 GMT -6 betts said:

I had one and they numbed me with something in a needle which didn't hurt at all. I didn't feel anything with the biopsy. They stitched it and it barely hurt at all. Stitches removed a week later.

This was my experience as well. It just itches as it healed.

[Deleted]

So would you folks who have done it suggest something for anxiety for him? He’s 6. He previously enjoyed getting his blood drawn, but after nurse Alice (name NOT changed to incriminate the guilty) failed to place an IV on her first 5-6 attempts, needles have been a problem. Not to the level of DD’s needle phobia, but definitely to the point of needing an extra set of hands to hold him down.

[beepers]

Is he mature enough to understand this is a “different” kind of needle? Meaning there won’t be multiple tries or failed attempts because they see exactly what they’re doing the whole time. They’re not trying to find a vein.

As a patient: Skin biopsies aren’t my favorite. Even though I was numbed, I still feel the surrounding skin move a little (sorry I’m trying to not get specific but hard to describe otherwise). But: the derm does this likely every single day. So they should be quick.

Personally I wouldn’t ask for anxiety meds for my kiddo. It’s all over so fast, and once the needle is in, he also thinks it’s “neat”. But you know your kid and there’s nothing wrong with asking for every available resource they need. Especially after the long drawn out process this has been.

[smilesp]

I’ve had a bunch of punch and shave biopsies. I prefer punch because the healing process is less painful IME and they don’t leave as much of a scar. The only thing that will be an issue is the numbing as he shouldn’t feel the actual biopsy at all. It is a prick and a sting. I have a 7 year old and I just try to be as honest as possible with these sorts of things like yes, it will be a prick and a sting but it will be quick. Would a distraction like a book or video help? Or the promise of a treat afterward? He will have a couple of stitches. My dermatologist always has me keep them moist with Vaseline and cover with a band aid for about 10 days. I don’t think I’ve ever had any pain after the procedure from a punch biopsy.

[senneth]

Does he respond to lidocaine? If yes, I don’t think a punch biopsy will be too bad?

If he doesn’t respond to lidocaine, it’s going to suck. I don’t particularly respond to lidocaine and punch biopsies and shave biopsies both suck. I will say punch biopsies are over very quickly.

If the Dr offers stitches, say yes! I was supposed to have 3 or 4 stitches after my first punch biopsy, and healing time was estimated to be a week. Then the dr realized I really don’t respond to lidocaine (I notified in advance, was told that wasn’t a thing), and the Dr refused to put in the stitches even though I sat still for the biopsies and begged him to do the stitches. Healing time without stitches was estimated to be 4-6 weeks.

Definitely ask about wound care - after my last biopsies the dermatologist had me use aquaphor, but hawkward recommended medical grade honey when I had a bad cut, and it worked so well (and my dr was absolutely fine with me trying it).

Healing is generally easier when it’s an area that doesn’t have a lot of friction.

[addymac]

Mar 7, 2023 21:10:22 GMT -6 senneth said:

Does he respond to lidocaine? If yes, I don’t think a punch biopsy will be too bad?

If he doesn’t respond to lidocaine, it’s going to suck. I don’t particularly respond to lidocaine and punch biopsies and shave biopsies both suck. I will say punch biopsies are over very quickly.

If the Dr offers stitches, say yes! I was supposed to have 3 or 4 stitches after my first punch biopsy, and healing time was estimated to be a week. Then the dr realized I really don’t respond to lidocaine (I notified in advance, was told that wasn’t a thing), and the Dr refused to put in the stitches even though I sat still for the biopsies and begged him to do the stitches. Healing time without stitches was estimated to be 4-6 weeks.

Definitely ask about wound care - after my last biopsies the dermatologist had me use aquaphor, but hawkward recommended medical grade honey when I had a bad cut, and it worked so well (and my dr was absolutely fine with me trying it).

Healing is generally easier when it’s an area that doesn’t have a lot of friction.

Oooh that reminds me.
I use medihoney (buy it off Amazon) when we have bad wounds on some of our babies at work and it helps so much. Our hospital pharmacy doesn’t carry it but when I get the OK from our docs and the pharmacist I use it on them. Works amazing for really bad diaper rashes and for wounds like ostomies where the skin is being destroyed by the acidity of poop. Makes sense to use it on skin wounds like what you use.

Improved Medihoney Gel Wound and & Burn Dressing from Derma Sciences, 0.5 oz, a.co/d/hAn8ABx

[Deleted]

They're moving the appointment up to today at 3:30.. less time for me to dwell sounded like a good option when they called with a cancellation. Thankfully I ordered the numbing cream yesterday and it's already been delivered. Adding the medihoney to my cart too.

Wish us luck. This kid is going to hate me.

[McBenny]

Mar 7, 2023 15:21:24 GMT -6 STP said:

I had four of them done on my breasts a couple years ago.

Honestly...it's going to suck and all you can do is get through it. Truly.

Prepare him as best you can, and just keep breathing through the whole thing. Give yourselves time to be upset after.

I'm sorry.

This is great advice. 

Mentally prepare yourself before hand is all I can say. 

My DD had it when very little.

[hawkward]

Mar 8, 2023 10:26:08 GMT -6 addymac said:

Mar 7, 2023 21:10:22 GMT -6 senneth said:

Does he respond to lidocaine? If yes, I don’t think a punch biopsy will be too bad?

If he doesn’t respond to lidocaine, it’s going to suck. I don’t particularly respond to lidocaine and punch biopsies and shave biopsies both suck. I will say punch biopsies are over very quickly.

If the Dr offers stitches, say yes! I was supposed to have 3 or 4 stitches after my first punch biopsy, and healing time was estimated to be a week. Then the dr realized I really don’t respond to lidocaine (I notified in advance, was told that wasn’t a thing), and the Dr refused to put in the stitches even though I sat still for the biopsies and begged him to do the stitches. Healing time without stitches was estimated to be 4-6 weeks.

Definitely ask about wound care - after my last biopsies the dermatologist had me use aquaphor, but hawkward recommended medical grade honey when I had a bad cut, and it worked so well (and my dr was absolutely fine with me trying it).

Healing is generally easier when it’s an area that doesn’t have a lot of friction.

Oooh that reminds me.
I use medihoney (buy it off Amazon) when we have bad wounds on some of our babies at work and it helps so much. Our hospital pharmacy doesn’t carry it but when I get the OK from our docs and the pharmacist I use it on them. Works amazing for really bad diaper rashes and for wounds like ostomies where the skin is being destroyed by the acidity of poop. Makes sense to use it on skin wounds like what you use.

Improved Medihoney Gel Wound and & Burn Dressing from Derma Sciences, 0.5 oz, a.co/d/hAn8ABx

This stuff is magic. I learned about it from a WOC nurse, and we use it on our kids. DS1 has eczema that occasionally causes open skin and DS2 has fragile Ehlers Danlos skin, and they both do so well with it.

[hawkward]

Mar 8, 2023 13:01:11 GMT -6 @dot said:

They're moving the appointment up to today at 3:30.. less time for me to dwell sounded like a good option when they called with a cancellation. Thankfully I ordered the numbing cream yesterday and it's already been delivered. Adding the medihoney to my cart too.

Wish us luck. This kid is going to hate me.

I’m glad you’re getting it over with. If it’s not too late, our derm orders intranasal meds to help kids relax. Our anesthesia team gives it and monitors the procedure. They usually go very smoothly.

[trueblue]

Positive thoughts you both survive with minimal emotional trauma @dot.

[Deleted]

We survived! The worst part was just getting him out of the car, followed by the shot. Of course after we got him stitched and ready to go, the doctor wanted to take a second sample “just in case” - which we skipped. Now we get ice cream before dinner and wait for results.

She suggested just using vasoline on it daily.