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A surgical pearl (in waiting) for the medical dermatologist

DII small banner By Warren R. Heymann, MD
Oct. 21, 2016

I admit it — the surgical aspect of my practice is rudimentary. Honestly, any non-cosmetic procedure that takes me more than 5 minutes gets referred. It’s amazing how I can make a living with shave biopsies, tangential excisions, electrodesiccation and curettage, and cryosurgery. Putting in a suture is an event.

I was enthralled with Bob Brodell’s lecture years ago about quick procedures for the medical dermatologist, focusing on punch excisions for epidermal cysts, pilar cysts, and lipomas. He and his colleagues have shown that this simple technique offers a recurrence rate of < 10%, if performed properly (1). Additionally, they have demonstrated a technique to remove larger oval lesions with a smaller round punch (2).

I have been so pleased with this technique that I never thought about how it could be improved, until I read the article by AlGhamdi describing the C-punch excision. The following is his abstract:

A conventional skin punch biopsy instrument has a circular hollow blade, which can be used to make a full circular incision to evacuate subcutaneous abnormalities such as lipomas. Here, we present a modified punch instrument, in which the cutting element has a C-shape to form a pivotal skin fragment (miniflap) to access subcutaneous tissues. The “C” part comprises almost half of a circle. The C-punch incision gives access to subcutaneous abnormalities, while keeping a connecting neck to the surrounding skin, which allows for efficient resealing of the skin surface. Therefore, there is less potential for subsequent scarring.
He concludes by stating: “The advantage of the C punch over the regular punch method is the restoration of normal skin after excision, minimizing defects and improving the final cosmetic outcome.” (3)

After reading this article, I thought that I could not wait to try it — unfortunately I will have to. Dr. AlGhamdi has the patent for the C-punch and it is currently not manufactured for commercial use. I wish him luck in bringing it to market for everyone’s benefit.

1. Mehrabi D, Leonhardt JM, Brodell RT. Removal of keratinous and pilar cysts with the punch excision technique: Analysis of surgical outcomes. Dermatol Surg 2002; 28: 673-7.
2. Warino LA, Brodell RT. Surgical pearl: Removal of large oval lesions with a smaller round punch. J Am Acad Dermatol 2006; 55: 509-10.
3. AlGhamdi KM. C-punch excision: A novel technique. Int J Dermatol 2016; 1154-6.

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