Have had 3 vulvar biopsies, 1st time was punch biopsy the others were not (special tool to carve out biopsy freehand + stitches) what's thedifference?

Size and location...: A punch for doing punch biopsies has a round cutting surface. They come in different sizes from 1mm to 6mm and up. Its a quick way to take a vulvar biopsy. But your doc can also use a scalpel or a pair of scissors to take a biopsy. It really depends where the problem is and what is best for the circumstances. A scalpel and stitches is usually used for larger biopsies. Best wishes!