Definitions:
Allergies - An allergy is an exaggerated immune response or reaction to substances that are generally not harmful.

Benign - The term "benign" refers to a condition, tumor, or growth that is NOT cancerous. This means that it does not spread to other parts of the body or invade and destroy nearby tissue. Benign tumors usually grow slowly. In general, a benign tumor or condition is not harmful. However, this is not always the case. If a benign tumor is big enough, its size and weight can press on nearby blood vessels, nerves, or organs, or otherwise cause problems. The opposite of benign is malignant.

Skin lesion aspiration - Skin lesion aspiration is the withdrawal of fluid from a skin lesion (sore).

Skin Lesion Biopsy is the process of removing a portion of skin from a patient for diagnostic examination.

Bleeding - A condition involving losing blood. This can occur internally (when blood leaks from blood vessels inside the body), externally through a natural opening (such as the vagina, mouth, or rectum), or externally through a break in the skin.

Chronic - A chronic condition is continuous or persistent over an extended period of time. A chronic condition is one that is long-standing, and not easily or quickly resolved.

Skin Graft - A skin graft is a patch of skin that is surgically removed from one area of the body and transplanted to another one.

Keloids - An overgrowth of scar tissue at the site of a healed skin injury.

Malignancy - The term malignancy refers to cancerous cells that usually have the ability to spread, invade, and destroy tissue. Malignant cells tend to have fast, uncontrolled growth. Malignant cells that are resistant to treatment may return after being removed or destroyed.

How the test is performed:
There are several methods for performing skin biopsies. Most procedures can be easily completed in outpatient medical offices. Choice of techniques is determined by several factors, including the location, size, and type of lesion to be biopsied. All methods should include local injection or topical application of an anesthetic.

The least invasive technique, the shave biopsy, involves the removal of superficial levels of skin. This type of biopsy does not require the use of sutures (stitches).

Punch biopsies are most often used for deeper skin lesions. A small cylinder of skin (usually the size of a pencil eraser) is removed with a sharp, hollow instrument. If a large sample is taken, the area may be closed with stitches.

In an excisional biopsy, the entire clinical lesion is removed. A local anesthetic is injected. Then the entire lump, spot, or sore is removed, going as deep as necessary to get the entire area. The incision is then closed with stitches. Bleeding is controlled by pressure. If a large area is biopsied, a skin graft or flap of normal skin may be used to replace it.

How to prepare for the test:
You must understand the risks, benefits, and alternatives explained to you by your physician before giving consent to any procedure. Please provide detailed information to your doctor about any allergies you have, medications you are taking (including vitamins and supplements, herbal remedies, and over-the-counter preparations), or if you have bleeding problems and/ or if you are pregnant.

How the test will feel:
There is a brief prick and sting as the anesthetic is injected. Afterward, the area may be tender.

Why the test is performed:
The test is used to identify cancers and benign growths, to help diagnose chronic bacterial and fungal skin infections, and to identify other skin conditions.

What abnormal results mean:
The test may reveal skin cancers or benign (noncancerous) conditions. Bacteria and fungi can be identified. The test may also reveal some inflammatory diseases of the skin.

What the risks are:
Any time the skin barrier is broken, there is a chance of infection. If you tend to form large scars (keloids) in response to a skin injury, there is a fair chance one will form over the biopsy area. You may lose a very small amount of blood during the procedure.

Special considerations:
Fluid-filled lesions may be examined by skin lesion aspiration instead of skin lesion biopsy.

Infants and children:

The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experiences, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

Infant test or procedure preparation (birth to 1 year)
Before the test, know that your child probably will cry, and restraints may be used. The most important way you can help your child through this procedure is by being there and showing you care. Crying is a normal response to the strange environment, unfamiliar people, restraints, and separation from you. Your infant will cry more for these reasons than because the test or procedure is uncomfortable.

Your presence helps your infant during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or your health care provider's office, you will most likely be given the opportunity to be present. If you are not asked to be by your child's side and would like to be, ask your provider if this is possible. If you think you may become ill or anxious, consider keeping your distance, but remaining in your infant's line of vision. If you are not able to be present, leaving a familiar object with your infant may be comforting.

OTHER CONSIDERATIONS

• Ask your provider to limit the number of strangers entering and leaving the room during the procedure, since this can raise anxiety.
• Ask that the provider who has spent the most time with your child perform the procedure.
• Ask that anesthetics be used where appropriate to reduce the level of discomfort your child will feel.
  Ask that painful procedures not be performed in the hospital crib, so that the infant does not come to associate pain with the crib. Many hospitals have special treatment rooms where procedures are performed.
• Imitate the behavior you or your health care provider need the infant to do, such as opening the mouth.
• Many children's hospitals have child life specialists who are specially trained to educate patients and families and advocate for them during procedures. Ask if one is available.

Toddler test or procedure preparation (1 to 3 years)
Before the test, know that your child probably will cry, and that preparation may not change the fact that your child will feel some discomfort or pain. Try using play to demonstrate what will happen during the test. You may be able to uncover your child's concerns. The most important way you can help your child is by preparing them and by providing support at the time of the procedure.

Your presence helps your child during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or your health care provider's office, you will most likely be given the opportunity to be present. If this is unclear, ask if it is possible for you to be present. If you think you may become ill or anxious, consider keeping your distance while remaining in your child's line of vision. If you are not able to be present, leaving a familiar object with your child may be comforting.

OTHER CONSIDERATIONS

• Your child will probably resist the procedure and may even try to run away. A firm, direct approach from you and the health care staff may be helpful.
• Give one direction at a time during the procedure using 1- or 2-word commands.
• Ask your health care provider to limit the number of strangers entering and leaving the room during the procedure, since their presence can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure.
• Ask that anesthesia be used where appropriate to reduce the level of discomfort your child will feel.
• Ask that painful procedures not be performed in the crib, so that the child does not associate pain with the crib.
• If you are in your child's line of sight, imitate the behavior the the child needs to do, such as opening the mouth.

Preschooler test or procedure preparation (3 to 6 years)
Before the test, understand that your child probably will cry, and that preparation may not change the fact that your child will feel some discomfort or pain. You can try demonstrating what will happen during the test in advance to learn about your child's particular fears and concerns. Using a doll or other object to act out the test may help reveal worries that the child may not be willing to discuss directly.

Your presence may help your child during the procedure, especially if the procedure allows you to maintain physical contact. If the procedure is performed at the hospital or your health care provider's office, you may be given the opportunity to be present. If you are not sure that you are allowed to be present, ask. If you think you may become ill or anxious, consider keeping your distance but remaining in your child's line of vision. If you are not able to be present, leaving a familiar object with your child may be comforting.

OTHER CONSIDERATIONS

• Ask your provider to limit the number of strangers entering and leaving the room during the procedure, since this can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure.
• Ask that anesthesia be used where appropriate to reduce the level of discomfort your child will feel.
• Ask that painful procedures not be performed in the hospital bed, so that the child does not associate pain with the hospital room.
• If you are in your child's line of sight, imitate the behavior the the child needs to do, such as opening the mouth.

Schoolage test or procedure preparation (6 to 12 years)
Understand that your child probably will cry, and that preparation may not change the fact that your child will feel some discomfort or pain. Use play to demonstrate what will happen during the test. You may also discover your child's concerns about the test. The most important way you can help is by preparing your child ahead of time, and supporting the child during the procedure. Explaining the procedure will be of value in reducing your child's anxiety. Let your child participate and make as many decisions as possible.

If the procedure is performed at the hospital or your health care provider's office, you will most likely be given the opportunity to be present. Ask your provider if you are not sure about this. If your child does not want you to be present, it is best to honor this wish. Out of respect for your child's growing need for privacy, do not allow peers or siblings to view the procedure, unless this is allowed and requested by the child.

OTHER CONSIDERATIONS

• Ask your provider to limit the number of strangers entering and leaving the room during the procedure, since this can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure.
• Ask that anesthesia be used where appropriate to reduce the level of discomfort your child will feel.
• Ask that painful procedures not be performed in the hospital bed or room so the child does not associate pain with these areas.

Adolescent test or procedure preparation (12 to 18 years)
First, provide detailed information and explain reasons for the procedure. Let your child participate in making as many decisions as possible. Be honest about discomfort that may be felt, but don't dwell on the topic. It may help to stress the benefits of the procedure, and that you will have more information when the results are in. Talk about things that the child may find pleasurable after the test, such as feeling better, or going home. Rewards, such as shopping trips or movies, may be helpful if the child is able to enjoy them.

To the best of your ability, describe the operation of equipment that will be involved in concrete, literal terms. Discuss potential risks. Adolescents commonly have elevated concerns about risks, particularly about any effects on appearance, mental function, and sexuality. Address these fears honestly and openly if at all possible. Provide information about any appearance changes or other possible side effects that may result from the test.

Older children may benefit from videos that demonstrate children of the same age explaining and undergoing the procedure. Ask your health care provider if such films are available for your child's viewing.

If the procedure is performed at the hospital or your health care provider's office, ask the provider if you may be present with your child. However, if your child does not want you to be present, and it is best to honor this wish. Out of respect for your child's growing need for privacy, do not allow peers or siblings to view the procedure unless the adolescent wants them to be present.

OTHER CONSIDERATIONS

• Ask your health care provider to limit the number of strangers entering and leaving the room during the procedure, since this can raise anxiety.
• Ask that the provider who has spent the most time with your child be present during the procedure, if possible.
• Your adolescent may have difficulty with a new authority figure entering the situation. This complication can be minimized if a familiar provider performs the test. Otherwise, your child may offer some resistance to the procedure. Prepare the child in advance for the possibility that the test will be performed by someone unfamiliar, if this is likely to happen.
• Ask that anesthesia be used as appropriate to reduce the level of discomfort for your child.