A penis biopsy is a minor surgical procedure where a small piece of tissue is removed from an area of concern on the external male genitalia. This tissue sample is transported to a laboratory and examined by a pathologist under a microscope. The primary goal is to accurately identify the nature of any abnormal skin changes, lesions, or growths when less invasive tests cannot determine the cause.
Medical Reasons for a Biopsy
A healthcare provider typically recommends a penis biopsy when persistent, unexplained skin changes, such as suspicious lesions, growths, or ulcers, do not resolve with standard treatments. The biopsy definitively diagnoses the underlying cause of these abnormalities, which can range from inflammatory conditions to malignancies.
The most frequent indication for this procedure is to confirm the presence of penile cancer, which requires a biopsy for definitive diagnosis. It is also used to evaluate persistent skin conditions causing discoloration, thickening, or texture changes, such as Lichen sclerosus or Lichen planus. These inflammatory disorders require specific diagnosis and management to prevent long-term complications.
The biopsy also confirms precancerous conditions, known as penile intraepithelial neoplasia (PeIN). Examples include Erythroplasia of Queyrat (a velvety red plaque) and Bowenoid papulosis (small, reddish-brown papules). Identifying these precursors is important because they risk progressing to invasive cancer if left untreated. Microscopic examination determines the precise depth and extent of the abnormal cells, guiding subsequent treatment decisions.
Preparing for and Undergoing the Procedure
Preparation begins with reviewing current medications, as patients are usually instructed to temporarily stop taking blood-thinning agents like aspirin or NSAIDs for up to a week prior. This minimizes the risk of excessive bleeding. If general anesthesia is required for a more extensive biopsy, the patient may be asked to fast (no food or drink after midnight) the night before the appointment.
Patients are advised to shower using antibacterial soap on the day of the procedure to reduce the chance of infection. Wearing loose-fitting clothing is recommended to avoid irritation of the surgical site afterward. Since a local anesthetic is used, patients should arrange for a ride home, as driving may be restricted following the procedure.
The procedure is most often performed in an outpatient setting. It begins with the administration of a local anesthetic, frequently a penile nerve block, to numb the area. While the patient may feel pressure or a slight stinging sensation from the initial injection, the area will be numb during tissue removal. The choice of biopsy technique is determined by the size, location, and nature of the lesion being sampled.
The most common method is the Punch Biopsy, which uses a specialized circular instrument to remove a small, cylindrical core of tissue, offering a full-thickness sample. Alternatively, a Shave Biopsy uses a sharp blade to remove only the top layer of skin, suitable for superficial lesions. If the abnormal area is small, an Excisional Biopsy may be performed, removing the entire lesion for both diagnosis and treatment.
For a larger or deeper lesion, an Incisional Biopsy is used, where only a representative portion of the tissue is surgically cut out. Once the sample is secured, the biopsy site is closed, often using dissolvable stitches. In some cases, especially with shave biopsies, the site may be closed using chemical cauterization to stop bleeding rather than sutures.
Post-Procedure Care and Understanding Results
Following the procedure, patients receive specific instructions for wound care to promote healing and prevent infection. It is recommended to keep the biopsy site clean and dry for the first 24 to 48 hours, avoiding direct water exposure. Simple over-the-counter pain relievers, such as acetaminophen or ibuprofen, can manage any mild discomfort or bruising as the local anesthetic wears off.
A small dressing may be applied, and the patient will be instructed on when and how to change it, usually keeping the area supported with snug-fitting underwear. Healing time varies depending on the biopsy type and depth, with most sites taking one to three weeks to fully recover. Patients must avoid strenuous activities and heavy lifting for at least two weeks to prevent strain on the incision site.
Sexual activity must be avoided until the wound is completely healed and any sutures have dissolved, which can take up to four to six weeks. Patients must watch carefully for signs of complications requiring immediate medical attention. These warning signs include:
- Excessive bleeding that soaks through the dressing.
- Increasing redness or swelling.
- A foul-smelling discharge.
- A fever.
Once the tissue sample is collected, it is sent to a pathology lab for detailed analysis, where the pathologist prepares a comprehensive report. The turnaround time for this report is usually several days to two weeks, depending on the complexity of the testing required. The final report categorizes the findings as benign (non-cancerous), precancerous, or malignant (cancerous).
The healthcare provider schedules a follow-up appointment to discuss the results, explain the diagnosis, and outline the next steps. The biopsy provides the necessary data to formulate an appropriate and targeted treatment plan, whether the diagnosis is an inflammatory condition or a malignancy.