Functional Medicine Explained for Skim Health & Inflammation

Improve your understanding of inflammation affecting skin health and the role of functional medicine in skin care solutions.

Abstract

Welcome to the Injury Medical Clinic educational platform. I’m Dr. Alex Jimenez, and today, we embark on an in-depth exploration of a fundamental dermatological procedure: the shave skin biopsy. This post takes you through the entire process, from initial patient presentation to the procedure itself and the crucial follow-up care. We will explore the cellular and physiological reasons behind each step, including why a particular lesion might warrant a biopsy, how local anesthetics like lidocaine with epinephrine work, the precise mechanical technique of the shave biopsy, and methods for achieving hemostasis. Beyond the procedure, we will connect these clinical practices to a broader, integrative framework. I will explain how our unique multidisciplinary model in El Paso, Texas, combines my expertise in chiropractic, functional, and family medicine with the invaluable medical oversight of Dr. Maria Guadalupe Cardenas, MD, an internist with over four decades of experience, to provide comprehensive patient care. We explore how chronic inflammation, musculoskeletal imbalances, and metabolic dysfunction—hallmarks of functional and chiropractic medicine—can show up on the skin, making an integrative approach essential for true, long-term health and wellness. This comprehensive guide shows how modern, evidence-based research informs our daily practice, giving you a transparent, thorough understanding of how we manage skin health concerns within a holistic, patient-centered paradigm.

Understanding the Clinical Presentation: When a Skin Lesion Needs Investigation

In my years of practice, as both a Doctor of Chiropractic and a Family Nurse Practitioner, I have come to appreciate the skin as a remarkable window into the body’s internal state. It is far more than a simple protective barrier; it is a dynamic organ that often signals underlying systemic issues. Today, I want to walk you through a common clinical scenario that many of us may encounter: the appearance of a new or changing skin lesion.

The Patient’s Story: A Case Presentation

Let’s begin with a typical case that we might see at our clinic. A middle-aged man presents with a specific concern: a skin lesion on the lateral aspect of his right hip. He reports that this lesion has become particularly noticeable over the past four weeks. This timeframe is crucial. A recent change is a red flag in dermatology and raises clinical suspicion. The patient also describes associated inflammation and pain, which are classic signs that the body’s immune system has been activated in that area. The lesion has also been enlarging.

On examination, my initial clinical assessment points toward an inflamed seborrheic keratosis. Here’s what that means.

• Seborrheic Keratosis (SK): These are some of the most common noncancerous skin growths in older adults. They often appear as brown, black, or light tan growths on the face, chest, shoulders, or back. They have a waxy, scaly, and slightly elevated appearance. Often called the “barnacles of aging,” they are generally harmless. However, they can sometimes mimic more serious skin conditions, including melanoma, which is why a definitive diagnosis matters.
• Inflamed: The term “inflamed” is key here. While a typical SK is usually asymptomatic, it can become irritated and inflamed due to friction from clothing, accidental scratching, or other forms of trauma. This inflammation can cause redness, swelling, and pain, which are the exact symptoms our patient is reporting. The inflammation itself can also cause the lesion to change in appearance, sometimes rapidly, which can be alarming for both the patient and the clinician.

Given these factors—the recent, rapid change; the inflammation; the pain; and the clinical appearance that could mimic something more sinister—we decided to perform a shave skin biopsy. This is a diagnostic procedure, not a therapeutic one at this stage. The primary goal is to obtain a tissue sample to send to a pathologist for histopathological examination. This microscopic analysis is the gold standard for definitively identifying the lesion and ruling out malignancy.

The Power of Collaboration: Our Integrative Model at Injury Medical Clinic

Before we dive into the technical aspects of the biopsy procedure, I want to explain the unique clinical environment in which we deliver this care. Here at Injury Medical Clinic PA in El Paso, Texas, we operate on a multidisciplinary platform. I, Dr. Alex Jimenez, bring a diverse background that spans chiropractic (DC), advanced practice nursing (APRN, FNP-BC), and functional medicine (CFMP, IFMCP). This allows me to view patient health through multiple lenses, from musculoskeletal alignment and neurological function to metabolic health and cellular biology.

However, this comprehensive approach is made possible and is medically fortified through my collaborative relationship with Dr. Maria Guadalupe Cardenas, MD. Dr. Cardenas is a highly respected, board-certified Internist with over 40 years of invaluable experience. She serves as our Medical Director and Collaborative Physician. This collaborative physician agreement is a formal structure in which an MD provides medical oversight, guidance, and consultation for the services provided by an advanced practice provider like me.

This MD-DC-APRN integration is the cornerstone of our practice. It means that when a patient like the gentleman with the skin lesion comes to us, their care is not siloed.

• From a family medicine perspective (as an FNP), I can perform the diagnostic procedure, prescribe necessary medications, and manage the primary care aspect of the skin condition.
• From a functional medicine perspective, I am trained to ask “why” this inflammation is occurring. Is there an underlying immune dysregulation? A nutritional deficiency? A gut-health issue manifesting on the skin? We look at the body as an interconnected system.
• From a chiropractic perspective, especially with a lesion on the hip, I consider biomechanical factors. Is the irritation from a waistband exacerbated by a pelvic tilt or a gait abnormality that we can address with chiropractic adjustments? Chronic friction is a well-known trigger for skin inflammation.
• Most importantly, all of this is done under the watchful eye and with the deep medical wisdom of Cardenas. She reviews complex cases, provides consultations, and ensures our diagnostic and treatment plans meet the highest standards of medical care. This is particularly crucial when we are ruling out serious conditions like skin cancer. Her expertise as an internist provides a layer of diagnostic rigor and safety that elevates the quality of care for every single patient.

This model ensures that our patients receive the best of all worlds: the holistic, systems-based approach of functional and chiropractic medicine combined with the rigorous, evidence-based standards of conventional allopathic medicine. This patient-centered framework is designed for safety, efficacy, and true holistic wellness.

Preparing for the Procedure: Anesthesia and Patient Comfort

Now, let’s return to our patient. We’ve decided that a shave biopsy is necessary. The first and most critical step before any incision is to ensure the patient is comfortable and the area is properly anesthetized. This isn’t just about patient comfort; it’s about procedural success. A calm, still patient allows for a more precise and safer procedure.

Step 1: Cleansing the Site

The first thing I do is thoroughly cleanse the area with an alcohol pad. This is a fundamental principle of asepsis. A vast microbiome of bacteria, fungi, and viruses colonizes the skin. While many are commensal or even beneficial, introducing them into the deeper layers of the dermis or subcutaneous tissue via a needle or a blade can lead to a post-procedural infection (cellulitis). Isopropyl alcohol is an effective antiseptic that denatures microbial proteins, killing them on the surface and reducing contamination risk.

Step 2: Topical Vapocoolant Spray

Even a tiny needle can cause a moment of sharp pain and anxiety for the patient. To mitigate this initial sting, I use a vapocoolant spray, in this case, Pain Ease® mist.

• Mechanism of Action: These sprays typically contain a volatile chemical like ethyl chloride or a proprietary blend of tetrafluoroethane, pentafluoropropane, and tetrafluoropropene. When sprayed onto the skin, these liquids evaporate almost instantly. This rapid evaporation is an endothermic process, meaning it absorbs heat from the surrounding environment—in this case, the patient’s skin. This causes a rapid and intense cooling of the superficial nerve endings (nociceptors) in the epidermis.
• Physiological Effect: The intense cold signal temporarily overrides the pain signal. According to the Gate Control Theory of Pain, proposed by Melzack and Wall in 1965, non-painful stimuli can “close the gates” to painful stimuli. The cold sensation travels along large, fast-conducting A-beta nerve fibers, while the needle-prick pain travels along smaller, slower A-delta and C fibers. The activation of the A-beta fibers stimulates inhibitory interneurons in the spinal cord’s dorsal horn, which in turn dampens the transmission of the pain signal from the A-delta and C fibers to the brain. In essence, the brain is “distracted” by the cold, and the perception of the needle stick is significantly reduced.

This simple, quick step makes a world of difference in the patient’s experience and sets a positive tone for the rest of the procedure.

Step 3: The Local Anesthetic Injection

With the cold spray momentarily numbing the surface, I proceed with the local anesthetic injection. This is the most crucial part of the pain management strategy.

• The Choice of Needle: I use a 30-gauge, half-inch needle. The gauge of a needle refers to its diameter; the higher the gauge number, the smaller the diameter. A 30-gauge needle is very fine, which minimizes tissue trauma and insertion pain. A half-inch length is ideal for reaching the subcutaneous tissue without going too deep, which is perfect for a superficial procedure like a shave biopsy.
• The Anesthetic Agent: The choice of anesthetic is 1% lidocaine with epinephrine. This is a standard and highly effective combination, and it’s important to understand the role of each component.
  • Lidocaine (1%): Lidocaine is an amide-type local anesthetic. Its primary function is to block nerve conduction, thereby preventing the transmission of pain signals from the procedure site to the brain. It achieves this by reversibly binding to voltage-gated sodium (Na+) channels on the intracellular side of the nerve membrane. In a resting nerve, these channels are closed. When a pain stimulus occurs, it depolarizes the nerve membrane and opens these sodium channels. Sodium ions rush into the cell, propagating the action potential (the nerve signal). Lidocaine stabilizes the channel in an inactivated state, physically blocking sodium influx. Without this sodium influx, the nerve cannot depolarize, the action potential cannot be generated, and the sensation of pain is completely blocked. A 1% solution provides a sufficient concentration for rapid onset and effective anesthesia for a minor procedure.
  • Epinephrine: Epinephrine (also known as adrenaline) is a powerful vasoconstrictor. It is added to lidocaine for two very important reasons.

1. 1. 1. Prolonged Duration of Action: By constricting the small blood vessels (arterioles and capillaries) in the area of the injection, epinephrine reduces local blood flow. This slowing of blood flow means that the lidocaine is not washed away from the injection site as quickly. It remains concentrated around the local nerves longer, significantly extending the anesthetic effect. This keeps the area numb throughout the procedure and afterward, improving post-procedural comfort.
      2. Hemostasis: The vasoconstrictive effect also provides preemptive hemostasis. By reducing blood flow to the area before the incision is even made, it minimizes bleeding during the biopsy. This is incredibly helpful because it keeps the surgical field clear, allowing for a more precise, cleaner shave. A bloodless field is a safe field.

It’s important to note that anesthetics containing epinephrine are generally avoided in areas with end arteries, such as the fingers, toes, nose, ears, and penis. The profound vasoconstriction in these areas could potentially compromise blood supply and lead to tissue necrosis. However, for a well-vascularized area like the hip, it is perfectly safe and highly advantageous.

The Injection Technique: Creating the “Wheal”

The injection technique is just as important as the anesthetic agent itself. My goal is to deliver the anesthetic precisely where it’s needed for a shave biopsy.

1. Initial Subcutaneous Injection: I quickly insert the needle into the subcutaneous tissue (the fatty layer just beneath the dermis). I aspirate briefly by pulling back on the plunger to ensure I haven’t entered a blood vessel, then inject about 1 mL of the solution. This initial anesthetic depot begins to numb the deeper tissues and the nerves supplying the overlying skin. The patient reported no pain during this part, which speaks to the effectiveness of the vapocoolant spray and the fine-gauge needle.
2. Redirecting for the Intradermal Wheal: Now for the key part of the technique. Without pulling the needle completely out of the skin, I redirect it, angling it to run horizontally just beneath the epidermis, directly under the lesion. This is an intradermal injection. As I slowly inject the remaining anesthetic into this very superficial plane, a visible, pale, and firm elevation of the skin forms. This is called a wheal.

The creation of the intradermal wheal is a brilliant and elegant technique that serves three simultaneous purposes:

• Profound Anesthesia: The dermis is densely populated with nerve endings. Injecting the anesthetic directly into this layer ensures that the most sensitive part of the skin is profoundly numb. The wheal visually confirms that the anesthetic is in the correct plane to block these superficial nerves.
• Mechanical Elevation of the Lesion: The injection fluid physically pushes the lesion up and away from the deeper tissues. It essentially “presents” the lesion on a platter. This elevation makes it much easier to get the biopsy blade flush with the skin and control the shave depth. It minimizes the risk of going too deep or taking an incomplete sample.
• Turgor and Firmness: The fluid pressure creates turgor in the skin, making the surface firm. It’s much easier to slice through a firm surface than a soft, pliable one. This allows for a smooth, single-pass motion with the blade, resulting in a cleaner cut and a better cosmetic outcome.

As I’m injecting, I’m watching the wheal form and confirming with the patient that they are not feeling any stinging. The initial subcutaneous injection often numbs the area enough that the intradermal part is painless. The fact that the patient reported no pain indicates that the anesthetic from the first injection had already taken effect. This careful, multi-step anesthetic technique ensures the procedure is not only painless but also technically easier and safer to perform.

The Shave Biopsy: A Precise Surgical Technique

With the lesion now perfectly anesthetized and elevated, we are ready for the biopsy itself. The term “shave biopsy” accurately describes the motion: a horizontal slicing, or “shaving,” of the lesion off the skin’s surface.

The Instrument of Choice

For a shave biopsy, clinicians often use a specialized tool. This could be a #15 scalpel blade, but often a Dermablade® or similar flexible razor blade designed for this purpose is preferred. These blades are extremely sharp and often flexible, allowing them to conform to the skin’s contours. The choice of instrument depends on the size and shape of the lesion, as well as clinician preference. The key is extreme sharpness to ensure a clean cut with minimal tissue trauma.

The Technique: A Step-by-Step Execution

1. Positioning and Tension: I use my non-dominant hand to apply gentle three-point traction to the skin surrounding the wheal. This further stabilizes the area and tightens the skin. This is a critical step. Cutting on lax skin can cause it to bunch up, leading to uneven cut depth and a jagged wound.
2. Initiating the Cut: The shave begins approximately one to two millimeters lateral to the visible edge of the lesion. This ensures the initial cut is in normal, healthy skin, which helps establish the correct depth. Hold the blade parallel to the skin surface.
3. The Shaving Motion: With a steady, fluid motion, advance the blade through the dermis, moving horizontally underneath the lesion. The goal is to keep the blade in the papillary or superficial reticular dermis. The depth is critical.

• • Too shallow: If the shave is too superficial, it may not capture the entire lesion, especially the base. This can lead to a “positive margin” on the pathology report, meaning the lesion extends to the edge of the sample, and we cannot be certain it was fully removed. It may also be insufficient for the pathologist to make an accurate diagnosis, particularly if the diagnostic features are at the base of the lesion (e.g., in a suspected nodular melanoma).
  • Too deep: If the shave is too deep, it can cause more significant scarring, a higher risk of bleeding, and longer healing time. A deep shave essentially becomes an excision, which is not the goal here.

The technique I am demonstrating involves a smooth, sawing-like motion. I am moving the blade back and forth slightly as I advance it forward. This helps the sharp edge slice through the dermal collagen fibers cleanly rather than tearing them. The elevated wheal created by the anesthetic acts as a perfect guide, allowing me to see exactly where my blade is in relation to the lesion’s base.

• Completing the Shave: I continue this motion through to the other side of the lesion, again exiting about one to two millimeters into normal skin on the opposite side. This ensures that the entire lesion, along with a tiny rim of normal-appearing skin, is captured in the specimen. The goal is to remove the lesion in a single, cohesive piece. When complete, we are left with a flat, superficial wound bed and, ideally, no visible remnant of the lesion on the skin.

Handling the Specimen

Once you free the tissue sample, handle it with care. I use fine-toothed forceps to gently pick it up, being careful not to crush it. Crushing the tissue can create artifacts that make the pathologist’s job much more difficult. The specimen is then immediately placed in a specimen jar containing a fixative, typically 10% neutral buffered formalin.

• The Role of Formalin: Formalin is a cross-linking fixative. It forms methylene bridges between tissue proteins. This process permanently locks the cellular architecture in place, preventing autolysis (self-digestion by the cell’s own enzymes) and putrefaction (breakdown by bacteria). It essentially “freezes” the tissue in a life-like state, preserving the cellular details that are essential for an accurate histopathological diagnosis. The specimen jar is then carefully labeled with the patient’s name, date of birth, procedure date, and the precise anatomical location of the biopsy (“lateral right hip”). An accompanying pathology request form will include the patient’s history, a clinical description of the lesion, and my differential diagnosis (e.g., “inflamed seborrheic keratosis vs. atypical nevus vs. squamous cell carcinoma”). This clinical context is vital for the pathologist.

Achieving Hemostasis: Controlling the Bleeding

We have now created a superficial open wound in the dermis, which is a highly vascular layer of the skin. Therefore, bleeding is expected. The final step is to achieve hemostasis, or the cessation of bleeding. While the epinephrine in the anesthetic provides excellent preemptive hemostasis, some oozing will still occur from the cut capillaries in the wound bed.

My method of choice in this case is a chemical cauterizing agent: aluminum chloride.

• Mechanism of Action: I use a gauze pad saturated with aluminum chloride solution (commonly available as Drysol™ or a similar preparation, typically in a 20-25% concentration) and apply it to the wound bed with firm pressure for a minute or two. Aluminum chloride works as a hemostatic agent in two primary ways:

1. Mechanical Occlusion: It acts as a powerful protein precipitant. When it contacts blood and tissue proteins in the wound bed, it denatures and coagulates them. This forms a physical plug, or an eschar, that seals the ends of the severed capillaries.
2. Vasoconstriction: It also has a direct astringent effect, causing mild contraction of superficial blood vessels and further reducing blood flow.

Aluminum chloride is an excellent choice for superficial wounds like a shave biopsy site because it is fast-acting and effective. Generally, it does not cause significant tissue damage that would impair healing or lead to hyperpigmentation.

• Alternative Methods: Other common methods for hemostasis in this setting include:

• • Electrocautery/Electrosurgery: This involves using a hyfrecator or a similar device to deliver a high-frequency electrical current to the wound bed. The heat generated by the current instantly coagulates tissue and blood, providing very rapid and effective hemostasis. It is often used for more significant bleeding.
  • Silver Nitrate: Silver nitrate sticks work similarly to aluminum chloride, acting as a chemical cauterant that precipitates proteins and seals vessels. They can sometimes cause a temporary dark staining of the skin.
  • Ferric Subsulfate (Monsel’s Solution): Another effective chemical cauterant. However, it can sometimes deposit iron particles into the dermis, which can result in permanent “tattooing” of the site. Therefore, it is often avoided on cosmetically sensitive areas.

In this case, aluminum chloride was sufficient. After applying pressure with the saturated gauze, the bleeding stopped completely. The wound bed was clean and dry, ready for dressing.

Dressing the Wound

The final step is to apply a sterile dressing. This protects the wound from contamination, absorbs any minor residual oozing, and provides a moist environment conducive to healing.

1. Apply a thin layer of topical antibiotic ointment (like bacitracin or even simple petroleum jelly). The main benefit is less the antibiotic effect (which is debated for clean, minor surgical wounds) than creating a moist, occlusive barrier. Moist wound healing has been shown to accelerate re-epithelialization and produce better cosmetic outcomes with less scarring than letting a wound dry out and form a hard scab.
2. A sterile, non-adherent pad (like a Telfa™ pad) is placed over the ointment.
3. I secure it with adhesive tape or a Band-Aid.

I then provide the patient with clear post-procedure care instructions: keep the area clean and dry for the first 24 hours, then they can gently wash it daily with soap and water, reapply a thin layer of ointment, and cover it with a fresh Band-Aid until it is fully healed, which typically takes one to two weeks for a shave biopsy site. I also instruct them to watch for signs of infection, such as increasing redness, swelling, pus drainage, or fever, and to contact the clinic immediately if any of these occur.

The Healing Diet: Combat Inflammation, Embrace Wellness- Video

The Integrative Perspective: Connecting the Skin to Systemic Health

Now that we have walked through the entire procedure, let’s zoom back out and place this event within our broader integrative and functional medicine framework. A skin lesion is not just a “skin problem.” It is a local manifestation of a systemic process.

Inflammation: The Common Denominator

The patient presented with an inflamed seborrheic keratosis. The word “inflamed” is a major clue for a functional medicine practitioner. Chronic, low-grade inflammation is now understood to be a root cause of a vast array of chronic diseases, from cardiovascular disease and diabetes to autoimmune conditions and even certain cancers. The skin is often one of the first places this systemic inflammation becomes visible.

When I see an inflamed skin lesion, my mind immediately starts to consider the potential drivers of that inflammation:

• Dietary Triggers: The Standard American Diet (SAD), high in processed foods, refined sugars, unhealthy fats, and artificial additives, is profoundly pro-inflammatory. These foods can promote insulin resistance, oxidative stress, and the production of inflammatory cytokines that circulate throughout the body and can easily trigger a skin response.
• Gut Dysbiosis: Gut health is inextricably linked to skin health, a concept known as the gut-skin axis. An imbalance in the gut microbiome (dysbiosis), increased intestinal permeability (“leaky gut”), or infections like SIBO (Small Intestinal Bacterial Overgrowth) can allow bacterial fragments (like lipopolysaccharide, LPS) and undigested food particles to enter the bloodstream. This triggers a massive systemic immune response, driving up inflammation that can manifest as acne, eczema, psoriasis, or, as in this case, the inflammation of a previously benign lesion.
• Stress and the HPA Axis: Chronic psychological or physiological stress dysregulates the Hypothalamic-Pituitary-Adrenal (HPA) axis. This results in altered cortisol rhythms. While cortisol is anti-inflammatory in the short term, chronic elevation or dysregulation can lead to a pro-inflammatory state and impaired immune function, making the skin more susceptible to irritation and poor healing.
• Environmental Toxin Exposure: We are constantly exposed to toxins in our air, water, and food. These toxins can place a heavy burden on the body’s detoxification systems (primarily the liver and kidneys). When these systems are overwhelmed, the body may try to eliminate toxins through the skin, leading to inflammation and skin disorders.

So, while we are waiting for the pathology results to rule out malignancy, our functional medicine investigation begins. We might recommend advanced diagnostic testing, such as a comprehensive stool analysis to assess gut health, food sensitivity testing to identify dietary triggers, or an organic acids test (OAT) to evaluate metabolic pathways and detoxification capacity. The treatment plan would then be personalized to address these root causes, using diet modification, targeted nutritional supplementation (e.g., omega-3 fatty acids, curcumin, probiotics), and stress management techniques.

The Chiropractic and Biomechanical Connection

One might wonder: what does chiropractic have to do with a skin lesion? The connection can be surprisingly direct, especially given the lesion’s location on the lateral hip.

• Biomechanical Stress and Chronic Irritation: As a chiropractor, I am trained to assess and correct biomechanical imbalances of the musculoskeletal system. A common issue I see is a pelvic tilt or a leg-length discrepancy. This can cause a patient’s waistband or belt to sit unevenly and rub persistently on one hip. This chronic mechanical friction is a well-known trigger for irritating skin lesions like seborrheic keratoses or nevi (moles), causing them to become inflamed and enlarged.
• Nerve Function and Trophic Supply: Chiropractic care focuses on optimizing nervous system function by correcting vertebral subluxations and other spinal misalignments. The nervous system controls every body function, including blood flow, immune response, and skin tissue repair. The nerves that supply the skin on the lateral hip originate from the lumbar spine (specifically the L1-L3 nerve roots, which form the lateral femoral cutaneous nerve and superior cluneal nerves). A subluxation or dysfunction in this area of the spine could potentially interfere with the normal nerve supply to that patch of skin, impairing its trophic function—its ability to heal, repair, and maintain health. This could make it more susceptible to inflammation or abnormal growth.

Therefore, as part of our integrative assessment, a chiropractic evaluation is warranted. If I find a pelvic obliquity or a lumbar spinal dysfunction, a course of chiropractic adjustments can restore proper alignment. This not only alleviates musculoskeletal pain but can also remove the source of chronic mechanical irritation on the skin lesion and optimize nerve function in the area, creating a better environment for healing post-biopsy and potentially preventing future irritation.

This is the beauty of our integrated model. The FNP in me addresses the immediate dermatological issue with a biopsy. The functional medicine practitioner in me investigates the underlying systemic inflammation. The chiropractor in me assesses and corrects the biomechanical stressors that may be contributing to the problem. And all of this is done with the medical oversight and collaborative wisdom of Dr. Cardenas, ensuring patient safety and diagnostic accuracy at every step.

Awaiting the Verdict: The Importance of Pathological Correlation

The shave biopsy is complete, the specimen is on its way to the lab, and the patient is on their way home with clear aftercare instructions. The next step is waiting, which can be anxious for the patient. We typically tell patients that pathology results will be back in about 7 to 14 days.

When the pathology report arrives, it is the moment of truth. A board-certified dermatopathologist slices the tissue into micro-thin sections, stains it with various dyes (most commonly hematoxylin and eosin, or H&E), and examines it under a microscope. The report will provide a definitive diagnosis.

• If the diagnosis is Inflamed Seborrheic Keratosis: This is great news. I will call the patient to inform them that the growth was benign (noncancerous). Since the shave biopsy often removes the entire lesion, it can be both diagnostic and therapeutic. No further treatment is typically needed for the site itself, other than allowing it to heal. However, this is where our functional medicine work becomes so important. We will use this as an opportunity to educate the patient about the inflammatory drivers we may have identified and continue working with them on dietary and lifestyle strategies to reduce their overall inflammatory burden and prevent other health issues down the line.
• If the diagnosis is a Malignancy: The report could come back as a form of skin cancer. The most common types we might find include:

• • Basal Cell Carcinoma (BCC): The most common type of skin cancer. It is slow-growing and very rarely metastasizes. A shave biopsy can sometimes be sufficient treatment if it’s a superficial type and the margins are clear. Otherwise, a more definitive treatment, such as excisional surgery or Mohs surgery, might be recommended.
  • Squamous Cell Carcinoma (SCC): The second most common type. It has a higher, though still low, potential to metastasize compared to BCC. A shave biopsy is typically only diagnostic for SCC. Standard care is usually full-thickness excision to ensure clear margins.
  • Melanoma: The most serious form of skin cancer. If a shave biopsy comes back as melanoma, it is a critical result. The most important piece of information on the pathology report is the Breslow depth, the tumor’s thickness measured in millimeters. This is the single most important prognostic factor for melanoma. A shave biopsy is not the ideal biopsy method for suspected melanoma because it can transect the base of the lesion, making an accurate Breslow depth measurement impossible (a “transected base”). This is why, for a lesion that is highly suspicious for melanoma clinically, an excisional biopsy is often preferred from the outset. However, if an incidental melanoma is found on a shave biopsy, the next step is immediate and urgent: a wide local excision of the biopsy site and possibly a sentinel lymph node biopsy to determine if the cancer has spread.

In any case of malignancy, ourclinic’s collaborative approach is paramount. I would immediately consult with Dr. Cardenas to review the pathology report. We would then contact the patient to discuss the diagnosis and formulate a plan for referral to a dermatologist or surgical oncologist for definitive treatment. Our role would then shift to providing supportive care, helping the patient navigate the healthcare system, and continuing to support their underlying health and resilience through functional and chiropractic medicine throughout cancer treatment and beyond.

Conclusion: A Journey of Integrated Care

The simple act of performing a shave biopsy on a skin lesion has taken us through multiple domains of medicine. We have touched on anatomy, physiology, pharmacology, surgical technique, and pathology. More importantly, we have seen how this single clinical event can open the door to a deeper, more holistic understanding of a patient’s health.

From the precision of injecting an intradermal wheal to the broad investigation of the gut-skin axis, our approach is meticulous and comprehensive. It honors the body’s intricate complexity and the interconnectedness of all its systems.

The collaborative partnership between me, with my background in chiropractic, nursing, and functional medicine, and Dr. Maria Cardenas, with her deep well of experience in internal medicine, forms the bedrock of this approach. It allows us to confidently manage a wide range of conditions, from the simple to the complex, always prioritizing patient safety, diagnostic accuracy, and long-term well-being.

The story of a skin lesion on the hip is not just a story about the skin. It’s a story about inflammation, biomechanics, gut health, and the powerful synergy possible when different medical disciplines come together for the patient’s benefit. At Injury Medical Clinic, we are proud to be part of this story every day. We believe that by treating the whole person—not just the lesion—we can guide our patients toward true, lasting health.

References

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2. Melzack, R., & Wall, P. D. (1965). Pain mechanisms: a new theory. Science, 150(3699), 971–979. [https://www.science.org/doi/10.1126/science.150.3699.971](https://www.science.org/doi/10.1126/science.150.3699.971)
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4. Salem, A., Nofal, A., & Ramadan, S. (2018). The Gut-Skin Axis: A new player in the field of dermatology. Dermatology and Therapy, 8(4), 517–528. [https://link.springer.com/article/10.1007/s13555-018-0255-z](https://link.springer.com/article/10.1007/s13555-018-0255-z)
5. Zuber, T. J. (2002). The shave biopsy: a guide to technique and training. American Family Physician, 65(6), 1165-1172. [https://www.aafp.org/pubs/afp/issues/2002/0315/p1165.html](https://www.aafp.org/pubs/afp/issues/2002/0315/p1165.html)

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