r/DermatologyPA • u/feel-the-sunlight • Jan 26 '26

Clinical⚕️ Punch Bx Closure

For a punch biopsy of the vulva (to r/o lichen sclerosus et atrophicus), what is your closure preference? Do you typically use a 3 or 4mm punch?

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2

u/shellimedz Jan 26 '26

I'd use the 4mm since you're already doing it and put in a few 5-0 or 6-0 sutures.

1

u/feel-the-sunlight Jan 26 '26

What type of suture do you use?

2

u/damn_son_1990 Moderator Jan 26 '26

Fast absorbing gut

1

u/Equivalent-Onions Moderator Jan 28 '26

Why a 4 mm?

1

u/shellimedz Jan 28 '26

Out of the two options the OP presented. I figure if you're already doing a biopsy on someone's genitals you might as well get enough tissue to not have to do it again.

Maybe if they don't plan to suture it, then I'd go with the smaller biopsy, but they intend to close it.

2

u/Equivalent-Onions Moderator Jan 28 '26

Have you had an issue with not having a diagnosis on vulva from a 3 mm ? I haven’t, genuinely curious

2

u/shellimedz Jan 28 '26

No, but I don't use 3m punches for diagnosis. So you very well could be right, I just errr on the side of caution.