Scalp Biopsies

Do Scalp Biopsies leave a scar?

The decision on whether or not to do a scalp biopsy is a big decision. A scalp biopsy is a short procedure whereby a cylindrical core of tissue is taken from the scalp. The size of the core is typically 4 mm in diameter. When the core is removed from the scalp, the area left behind is stitched up with sutures to assist in healing.

It does not matter how careful the biopsy or how beautiful the stitching the result is a small scar. Because scars are permanent, the patient will have a small scar in the area for life.

Sometimes a biopsy is essential. Differentiating complex diagnoses from one another sometimes requires a biopsy. Some forms of genetic hair loss are challenging to distinguish from telogen effluvium (especially early stages) and a biopsy may be helpful. Some forms of scarring alopecia are similar in some cases (discoid lupus vs lichen planopilaris). Some hair loss conditions need a biopsy because there are no other choices (for example ruling out breast cancer metastases to the scalp that perfectly mimic a single patch of alopecia areata). Overall, the use of a handheld dermatoscope in the clinic has greatly reduced the need for scalp biopsies. By carefully examining the scalp with a dermatoscope, features can he seen that can't be seen with the naked eye. Overall, I perform scalp biopsies on a very small minority of patients.

Unless it is absolutely critical to achieving the diagnosis, a scalp biopsy is not necessary.