Shave Biopsy or Excision

What is a shave biopsy or shave excision?

In a shave procedure, a raised skin lesion is removed under local anaesthetic by shaving it off level with the surrounding skin, using a blade held parallel to the skin surface. No stitches are needed.

When only part of a lesion is removed to make a diagnosis, it is called a shave biopsy. When the whole raised lesion is removed, it is called a shave excision. Either way, what is removed goes to the laboratory for microscopic examination.

What is it used for?

Shave procedures are used for raised lesions that sit mainly on the surface of the skin, such as raised, harmless moles that catch on clothing or are bothersome, seborrhoeic keratoses, skin tags and some other benign growths. A shave biopsy can also be used to sample a lesion to confirm a diagnosis.

Shave excision is not usually suitable for flat moles or for lesions where a skin cancer such as melanoma is suspected, because the full depth of the lesion may not be removed. In those situations, an excision is usually recommended instead.

Before your procedure

If you have private medical insurance, you will be given a procedure code. Please contact your insurer to obtain pre-authorisation, and check whether any excess applies, before booking. If you are self-funding, the clinic can give you the cost in advance.

Please tell us if you take any medicines that thin the blood, such as aspirin, clopidogrel, warfarin, apixaban or rivaroxaban, if you have a pacemaker or other implanted cardiac device, if you have ever reacted to a local anaesthetic, or if you are pregnant or breastfeeding. Do not stop any prescribed medicine unless you have been advised to.

You can eat and drink normally on the day. Try not to book the procedure in the two weeks before a holiday, an important event or a period of heavy physical activity, and avoid sun exposure, sea water and swimming while the wound heals.

If you need to cancel, please let the clinic know with as much notice as possible rather than on the day.

What happens on the day?

Dr Mounsey carries out the procedure himself. The area is cleaned and a small amount of local anaesthetic is injected under the lesion. This stings briefly, then the skin becomes numb. The lesion is shaved off level with the skin. The base is then sealed with a small electrical current (cautery) to stop bleeding, and a plaster is applied. You may notice a slight burning smell from the cautery, which is normal.

The procedure itself takes only a few minutes, and most appointments take around 20 to 30 minutes in total.

What to expect afterwards

The wound looks like a small, shallow graze or burn. It usually heals over one to three weeks, sometimes longer on the legs and back. It leaves a flat, round scar roughly the size of the original lesion, a little like a small cigarette burn mark. The scar is often pink or red at first and can be slightly paler, darker or shinier than the surrounding skin. It usually fades and becomes less noticeable over several months.

Because the base of the lesion is left in the skin, some pigment or a small bump can occasionally come back, particularly with moles.

Aftercare

Keep the plaster put on at the end of your procedure in place for the first 48 hours. After 48 hours, take it off, clean the wound with soap and water, then pat it dry. You can shower daily from this point. Each day, continue to clean the wound with soap and water, pat it dry, then apply a thin layer of Vaseline before putting on a fresh plaster. Continue this until the wound has healed. Keeping the wound moist in this way helps it heal faster and with a better scar than allowing a hard scab to form.

Avoid swimming, sea water, baths and hot tubs, and avoid picking any scab, until the wound has healed.

If the wound bleeds, press firmly on it with a clean, folded cloth or gauze for 10 to 15 minutes without lifting to check. If it is still bleeding after a second period of firm pressure, seek medical advice.

Paracetamol can be taken for discomfort once the local anaesthetic wears off. Avoid aspirin and anti-inflammatory painkillers such as ibuprofen for the first couple of days unless they have been prescribed for you, as they can increase bleeding. Avoiding alcohol for 48 hours and not smoking or vaping while the wound heals both help healing.

Contact the clinic if you notice signs of infection, such as increasing pain, redness, warmth or swelling around the wound, pus, or a fever, or if you have any other concerns.

Once the wound has fully healed, protect the scar from the sun with a broad-spectrum sunscreen of SPF 30 or above for at least six months, as sun exposure can darken or redden a new scar.

What are the risks?

Shave procedures are very safe. Risks include discomfort, bleeding, infection, slow healing, a scar that is paler, darker, indented or raised, and partial regrowth of the lesion. On the scalp or beard area, hair may not regrow within the scar. Rarely, a keloid scar can form, particularly on the chest, shoulders and upper back. Occasionally, the laboratory report shows that further treatment is needed.

Results and follow-up

Results are usually available within around two weeks. A follow-up appointment, which may be virtual, will be arranged to discuss the results and check the wound. If you have not heard about your results within three weeks, please contact the clinic.

More information

If you have any questions about your procedure, please contact the clinic before booking.

This page gives general information only and is not a substitute for a consultation. Everyone's skin is different, and what is right for you will depend on your own circumstances. If you are worried about a skin problem, please book an appointment with Dr Mounsey or speak to your GP. If you have a mole or skin lesion that is changing, bleeding or growing quickly, please seek medical advice promptly.