Shave Removal

Fig. 5.1

Shaving towards a finger

Solution

Place traction from behind the blade (Fig. 5.2).

Fig. 5.2

Traction (black arrow) placed 180° opposite to and from behind the blade’s trajectory (orange arrow)

Accidents Happen When

Traction is not placed behind the lesion, resulting in blade slippage and uncontrolled skin defects (Fig. 5.3). Placing two fingers on either side of the lesion for traction and cutting towards one finger risks laceration (Fig. 5.1).

Fig. 5.3

Failure to place traction results in pushing of slack skin, preventing controlled cutting. (a) Baseline. (b) Slack skin bunches up. When and how it gives is not under the control of the surgeon

Solution 1

Place traction behind the blade and cut opposite the direction of traction away from the retracting finger (Fig. 5.4).

Fig. 5.4

Correct application of traction for shave biopsy. (a) Finger applies traction in opposite direction of and from behind the blade. Hand will move toward the surgeon’s body as the shave progresses. (b) Angle blade for entry at 30–60°, making a superficial slit. (Not doing so results in bunching of the skin at the blade’s edge (Fig. 5.3b) and a sloppy, uncontrolled incision once the skin gives.). (c) Nestle the blade in the slit. Be sure to visualize the tip. (d) As it advances, turn blade parallel to the wound once desired depth is achieved

Solution 2

To address lax skin, pinch the skin under the target lesion so it rests at the apex of a taught bulge (Fig. 5.5).

Fig. 5.5

Pinching lax skin keeps fingers safe while providing traction. Biopsy depth will be deeper in the center of the lesion than at the periphery, and the resulting defect is often a divot (take care on the face). In some instances, the pinch technique can be used merely to make the initial, superficial incision, allowing conversion to the conventional traction technique (Fig. 5.4)

Solution 3

For facial skin or genital skin, place a finger under the lesion to tent the skin (Fig. 5.6).