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Topic: Skin punch biopsy - Anyone had one?

Forum: Not Diagnosed but Worried — Meet others worried about developing breast cancer for the first time.

Posted on: Jun 18, 2008 02:33PM

mindy25312 wrote:

For my peace of mind, I have decided to go ahead and have a skin punch biopsy to see if I have Paget's Breast Disease.  I have already been to 3 doctors who say that I do NOT have it, but there has been a definite change in color of my right areola, and the nipple is larger on that side.  Because there is no crustiness, oozing, itching, etc. (all the usual symptoms) the doctors are dismissing it as dry skin, etc.

One of my doctors made the remark that a biopsy of this type may leave me in pain for years when scar tissue forms.  Has anyone had a problem like that? 

I would appreciate hearing your experiences.  Thanks in advance!!

Mindy

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Jun 18, 2008 09:28PM, edited Jun 18, 2008 09:30PM by TenderIsOurMight


Oh Mindy,

How sad it is to me to see that a doctor, presumably a breast surgeon, would scare anyone by saying a punch biopsy may leave you in pain from scar for years to come. That's just not true, imho. Who are they to rob you of peace of mind in the presence of definitive nipple, areolar changes. Some of us here may attest that "could have, should have" in the form of a biopsy was not the right choice.

A punch biopsy is a removal of a small (variable mm size, depending on physicians choice) piece of tissue, done after a small amount of lidocaine injection. It's quick, small and usually doesn't need a stitch. I'm not sure why the term "punch biopsy" originated, as there is no real "punch" to it, as in a paper hole puncher. I think probably the word "punch" was chosen because the operator is taking a select piece of tissue from the surrounding tissue, but it instills much more dread than is worth.

Once that piece of tissue is removed and placed in formalin for the pathologist, you'll have some expert eyes giving the needed reassurance you need. The skin will fill in, much like it does with a cut, and a scab will form and then fall off. While there obviously are nerve fibers in the areolar complex, a small sample of tissue removed will not cause chronic pain!

I wish you fortitude through this as well as benign results. No one should be criticized for obtaining a biopsy imo; it's the biopsies not done which we on occasion lament the most.

All the best to you,
Tender

It cannot be emphasized too strongly that treatment of each patient is a highly individualized matter. (FDA-approved labeling for warfarin (Coumadin) NDA 9-218/5-105)

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Jun 20, 2008 12:47PM mindy25312 wrote:

TenderIsOurMight,

Thank you (and bless you) so much for your reasssurances.  It's one less thing to worry about.  Now I'm really annoyed with the dr. that told me this, since it's obviously not true and wonder if I should believe anything he says again....

You're an angel.  Thanks again!

Mindy

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Jun 20, 2008 01:30PM Rande wrote:

Dear Mindy,

I have had 3 bouts of DCIS since 1994. The last presented itself as Paget's of the nipple. I had a small red spot just next to the nipple and every so often it would itch or get some scaling. Then it would disappear, but would come back sometimes in a several week period. It was only on one breast which is why I questioned it with my breast surgeon and internist. Both kept saying that  because I had just had a lumpectomy and radiation for the second DCIS in my right breast that it was just dermatitis. They recommended different creams and lotions to try and it would work for a couple of days or a week and the "spot" would appear again. That was in 2003. The breast surgeon was going to do the punch biopsy in his office that Sept. The day that I went in for the biopsy there was nothing there! However, it came back again and would become irritated. They kept telling me that Paget's doesn't come and go, but I knew with that "gut feeling" that we sometimes get that something wasn't right. One of the main things being that it was only the one breast. Finally after much nagging from me my BS sent me to a dermatologist who did the punch biopsy and as Tender said it was a little thing with no pain. The first thing he said was that because it was only on one breast that would be his "first" reason for doing a biopsy. It came back positive for Paget's. Luckily, there was no underlying invasive tumor but more DCIS for the third time in 10 years in the same breast!. The oncologist recommended  a mastecomy with immediate reconstruction which is what I did in Nov. 2004. I don't want to frighten you, but had I not been aggressive who knows what would have been the out come if I had let it go. I am now 3 1/2 years NED. Hopefully, yours will be nothing, but you need the peace of mind to know for sure what you are dealing with. Please don't put off getting the biopsy as there is nothing to it. Praying for benign results for you.

Rose

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Jun 20, 2008 04:12PM mindy25312 wrote:

Hi Rose,

Glad that you're now fine!  Thank you for writing.  I have an app't with a surgeon Monday.  This will be my 5th doctor!  You mentioned going to an internist.  Would that be a good type of dr. for this type of thing?  In other words, do you think they would be knowledgable about breast diseases?  I have a question about your symptoms if you don't mind my asking:  Was the little red spot one of the normal little bumps on the areola that looked like it might be infected or was the spot flat?

You have really been through a lot with 3 bouts of DCIS!  You are absolutely right:  A patient has to be aggressive especially if she has that gut feeling that I'm starting to have.  Peace of mind is everything.

Hugs & thanks,

Mindy

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Jun 20, 2008 04:57PM otter wrote:

OK, what I'm about to say may be TMI.  (It took me 6 months to figure out that "TMI" means "too much information.)

The reason the procedure is called a "punch biopsy" is because it is done with an instrument called a "biopsy punch".  No joke.  But the doctor who said you would be "in pain for years when scar tissue forms," is either irresponsible or clueless.  They take a really tiny piece of tissue, and the site is numbed completely with local anesthetic first. Sometimes a single suture is used to close the gap that's created.  Here's a pic of a biopsy punch:

Here's a website that explains exactly how a punch biopsy is performed on skin (not on breast tissue).  It's written in medical terms that might make certain viewers squeamish, so I'm rating it PG and warning y'all:

http://www.aafp.org/afp/20020315/1155.html 

There's no reason to be concerned about a punch biopsy.  They're done all the time to help dx skin lesions.

otter 

Dx IDC, Stage I, Grade 2, 0/3 nodes, ER+/PR-, HER2-
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Jun 20, 2008 05:32PM Rande wrote:

Mindy, it was not one of the usual bumps. It was flat and would itch from time to time and the small area of skin would get flaky.  It would come and go. I think that was because of the radiation treatments that I had for the DCIS from Jan to March of 2003. That is what threw my BS off. He said Paget's does not usual come and go like that. I would recommend a dermatologist over an internist. My internist just happened to agree with my breast surgeon that it was dermatitis. I tried so many creams and lotion that I lost count. I just had this feeling that it was Paget's and I couldn't let it go and I am so glad that I didn't. Even the Radiation Oncologist questioned it, but because of the way it behaved she also thought that it was just dermatitis. But it is our lives and bodies at stake here and we have the right to search for the answer if we are not comfortable with what we have been told. Glad you have an appt Monday. Tell your doctor that you are uncomfortable with what you have been told and ask him to do the biopsy or recommend a dermatologist to look at it.

Lots of Hugs and will be thinking about you and praying for a good and speedy resolution to your problem.

Rose

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Jun 20, 2008 05:33PM Rande wrote:

Mindy, it was not one of the usual bumps. It was flat and would itch from time to time and the small area of skin would get flaky.  It would come and go. I think that was because of the radiation treatments that I had for the DCIS from Jan to March of 2003. That is what threw my BS off. He said Paget's does not usual come and go like that. I would recommend a dermatologist over an internist. My internist just happened to agree with my breast surgeon that it was dermatitis. I tried so many creams and lotion that I lost count. I just had this feeling that it was Paget's and I couldn't let it go and I am so glad that I didn't. Even the Radiation Oncologist questioned it, but because of the way it behaved she also thought that it was just dermatitis. But it is our lives and bodies at stake here and we have the right to search for the answer if we are not comfortable with what we have been told. Glad you have an appt Monday. Tell your doctor that you are uncomfortable with what you have been told and ask him to do the biopsy or recommend a dermatologist to look at it.

Lots of Hugs and will be thinking about you and praying for a good and speedy resolution to your problem.

Rose

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Jun 20, 2008 05:35PM Rande wrote:

Sorry, don't know why that submitted twice!

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Jun 20, 2008 06:19PM sueps wrote:

Mindy xxx

You will NOT be in pain for years !!

I had 2 at the same time in the same breast...there will be a loud bang when you have it done...and then my nurse applied loads of pressure afterwards to keep bruising minimal...I was fine to go to work the nxt day ...and 3 or 4 days the bruises started to clear .... xxx 

FOLLOWING THE YELLOW BRICKROAD WITH MY WONDERFUL SISTERS!

Dx 9/10/2007, IDC, 2cm, Stage I, Grade 3, 0/14 nodes, ER-/PR-, HER2-
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Jun 20, 2008 06:51PM mindy25312 wrote:

Thanks SO much Rande & Sueps!  I've always said "knowledge is power" so it helps to know the facts!  And wow!  Even a picture!  It doesn't look like anything I can't handle!

 I am still puzzled why my gynecologist told me that I could be in pain for years after I said I'd like to have a biopsy for my own peace of mind.  He wanted me to wait for a month to see if the dryness cleared up.  He said that is what he'd tell his sister to do.  Well, I'm not one to wait around. 

Oh, BTW, Rande, a dermatologist is one of the docs I've already seen.  He said it was some dry skin and gave me some hydrocortisone cream to use.  However, I believe he would do a biopsy if I asked him to.

Hugs & thanks to both of you ladies,

Mindy

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Dec 14, 2009 06:34PM, edited Feb 10, 2010 03:13PM by paradiseflower

You can see a punch biopsy done on YouTube....not for the squeamish.

Soon, no resident will say, "I am sick!"- Isaiah 33:24.