include alcohol-soaked cotton balls, 3-mil syringe filled with 1% lidocaine with epinephrine buffered with sodium bicarbonate, cotton tip applicators, 20% aluminum chloride, fine pick-ups and scissors, gauze, and formalin-filled biopsy bottle. Scissor biopsies are useful in the excision of pedunculated skin lesions such as skin tags, filiform warts, and polypoid melanocytic nevi. Indications include cosmesis, itching, irritation, or a tendency to catch on clothing. The area is draped, prepped and cleansed with an alcohol swab. A surgical pen is used to mark the lesion. 1% lidocaine with epinephrine buffered with sodium bicarbonate is used to anesthetize the area. Of note, very small lesions may be removed without anesthesia. Injury is confirmed by probing the biopsy site with the sharp end of the needle. A pick-up is used to stabilize the lesion, while the use of an iris or gradle scissor is used to snip the base of the lesion. Once the lesion is excised, hemostasis with the use of pressure or chemical is applied. In this case, 20% aluminum chloride at the end of a Q-tip is used as the hemostatic agent.

scissor biopsies

pedunculated skin lesions

skin tags

filiform warts

polypoid melanocytic nevi