To Evaluate the Efficacy of Diagnostic Periocular Punch Biopsy: Using a 4-mm Dermatology Punch.

Purpose: The dermatological punch biopsy is a minimally invasive procedure that provides conclusive diagnosis when managing periocular lesions. It aids with establishing histological diagnosis and subtype thereby facilitating management planning and eliminates the risk of unnecessary tissue sacrifice. The present literature provides limited evidence evaluating the value of punch biopsy in diagnosing periocular lesions.

Methods: A retrospective case note analysis of 400 consecutive 4-mm periocular punch biopsies performed between 2005 and 2016, from 353 patients was undertaken at a single institution. Three hundred fifty-nine lesions had an initial definite clinical diagnosis of malignancy (group A) and the remaining 41 lesions had an uncertain clinical diagnosis with enough suspicion to merit a biopsy (group B).

Results: In group A, 75.5% (n = 271) of the biopsies verified the clinical diagnosis of malignancy and 24.5% (n = 88) were benign. In group B, 70.7% (n = 29) of the lesions were benign and 29.3% (n = 12) were malignant and were subsequently treated as group A. Only 4, group A biopsies, which underwent formal excision, did not initially diagnose a malignancy (punch biopsy was repeated) providing a sensitivity of 98.6% and a specificity of 100%. One hundred seventeen were found to be benign avoiding unnecessary tissue sacrifice in 29.25% of cases.

Conclusion: Our study provides the largest sample size in the literature that evaluates a 4-mm diagnostic periocular punch biopsy in managing eyelid lesions. In 29.5% of punch biopsies, unnecessary tissue sacrifice was avoided as they were histologically benign. The authors found that punch biopsies for lesions <7 mm carry a risk of inadvertent excision of lesion.