Skin Biopsy & Surgical Excisions in Children

A skin biopsy involves taking a small sample of skin to help confirm a diagnosis under the microscope.

A surgical excision involves removing a skin lesion completely, either for diagnostic purposes or as treatment.

In paediatric patients, these procedures are recommended only when clinically indicated and when the benefits outweigh the risks.

Most skin conditions in children can be diagnosed clinically without surgery. However, a biopsy or excision may be recommended if:

• The diagnosis is uncertain

• A lesion is changing in appearance or behaviour

• Treatment decisions depend on confirming the diagnosis

• A lesion is symptomatic (painful, bleeding, or ulcerated)

Where possible, non-invasive approaches are always considered first.

The approach is individualised and depends on:

• The child’s age and developmental stage

• The size and location of the lesion

• The child’s ability to cooperate

For older or cooperative children, procedures can often be performed safely under local anaesthetic in a clinic setting.

For younger children or those who are anxious, additional support may be required. This can include:

• Nitrous oxide (happy gas)

• Procedural sedation

• General anaesthesia

When sedation or general anaesthesia is required, procedures are best coordinated in a hospital setting with appropriately trained medical and anaesthetic teams to ensure safety and comfort.

Some lesions are large, deep, or located in areas where simple biopsy or excision is not appropriate.

In these situations, management may involve a multidisciplinary approach, which can include:

• Paediatric surgeons

• Plastic surgeons

• Interventional radiologist

• Anaesthetist

This collaborative approach helps ensure accurate diagnosis, safe treatment, and the best possible outcome for the child.

After a biopsy or excision, results are reviewed and discussed with the family. Follow-up is arranged to:

• Review healing

• Discuss pathology results

• Plan any further management if required

Parents are provided with clear after-care advice and guidance on what to expect.

It is normal for parents and caregivers to feel anxious about procedures in children. Assessment includes discussion about:

• Whether a procedure is necessary

• Available alternatives

• Pain management and sedation options

• The most appropriate setting for the procedure

A dermatologist can help coordinate care in a way that prioritises the child’s comfort, safety, and emotional wellbeing.

At Ready Dermatology, North Shore Health Hub, St Leonards, our dermatologist provides assessment and coordination of skin biopsies and surgical excisions in children in accordance with Australian clinical standards. Care is individualised and, when required, involves collaboration with appropriate hospital-based teams and other specialists.