Skin Biopsy

If the physical examination shows evidence of a suspected melanoma, your doctor will recommend a skin biopsy, a procedure to remove all or part of the mole for evaluation under a microscope.

The biopsy provides 2 important pieces of information:

  • Whether the mole is benign or malignant
  • If malignant, how deeply the tumor has penetrated the skin and whether there are associated signs of ulceration

A skin biopsy is quick and about as uncomfortable as having blood drawn. The physician will clean the area to be biopsied with alcohol and then inject a small amount of local anesthetic. Because the anesthetic makes the skin swell and has a low pH, it burns for about 5 to 10 seconds. It is similar to the anesthetic used by dentists. Once the anesthetic has taken effect, the doctor will use a scalpel, a razor blade, or a small circular blade called a “punch” to free a small piece of skin. Because the skin is numb, the patient can feel pressure but no pain during this part of the procedure. If a deep biopsy is taken, 1 or 2 stitches are used to close the wound. If the biopsy is superficial, the wound is left open to heal like deep scrape. The whole process usually takes about 5 minutes.

Often, skin samples are sent to a dermatopathologist, a pathologist with additional training and certification in making diagnoses from skin biopsies.

Types of Biopsies

Different methods can be used to do a skin biopsy. Doctors will choose a method depending on the size of the affected area and the location on the body.

Excisional Biopsy

The doctor cuts out the entire suspicious lesion. This is the preferred method for small lesions.

  • Description: Typically, this would happen in the doctor’s office as an outpatient procedure, under a local anesthetic.
  • What you’ll feel: You will feel a needle stick and about 10 seconds of burning when the doctor anesthetizes the lesion. Once the spot is anesthetized you may feel pressure, but no pain from the surgery as the doctor cuts though the skin and removes the tumor. The doctor finishes by sewing the wound together.
  • How long does it take? The procedure usually takes less than an hour.
  • Afterwards: Some over-the-counter pain medication (your doctor should tell you which to take) will ease any pain coming from the site of the surgery. You’ll probably need a return visit for the doctor to remove stitches and check your healing.

Incisional Biopsy (for larger lesions)

The doctor may recommend taking just a portion of the lesion. This may occur because the lesion is too large for an excisional biopsy, or because taking it all would destroy important tissue, as on the face or hands, or leave scars.

  • Description: Incisional biopsies are performed in the doctor’s office under local anesthetic. One type, called a punch biopsy, uses an instrument that resembles a tiny, round cookie cutter with a diameter of 3, 4, or 6 millimeters (1/8″, 1/6″, or 1/4″). Incisional biopsies can also be made with a scalpel which will give you a more elliptical wound.
  • What you’ll feel: While it is a surgical procedure, you won’t experience much pain. You’ll feel a needle stick and a little burning with some pressure when you receive the anesthetic. But as it takes effect, you won’t feel any pain from the surgery as the doctor removes a portion of the lesion with the tool. The doctor finishes by sewing the wound together.
  • How long does it take? The procedure usually takes less than an hour.
  • Afterwards: Some over-the-counter pain medication (your doctor should tell you which to take) will ease any pain coming from the site of the surgery. You’ll probably need a return visit for the doctor to remove stitches and check your healing.

Superficial Shave Biopsy

This is a process used to diagnosis superficial skin disease when a deeper tissue cut isn’t required, such as melanoma in situ, skin tags or seborrheic keratoses.

  • Description: In a shave biopsy, the doctor numbs the area with a local anesthetic and then “shaves” off the top layers of the skin (the epidermis and a part of the dermis) with a surgical blade.
  • What you’ll feel: A needle stick and a little burning with some pressure when the anesthetic is injected. It is usually about as uncomfortable as having one’s blood drawn. Once the anesthetic takes effect, you may feel pressure, but no pain, as the physician shaves off of the top layers of skin.
  • Superficial Shave Biopsies are DISCOURAGED for suspected melanomas other than melanoma in situ.
  • Suspected melanomas require biopsies of the full thickness of the skin and underlying fat.
  • Superficial shave biopsies may not go deep enough to give an adequate tissue sample in order to determine tumor depth, ulceration or mitotic index.
  • Other superficial techniques such as freezing and cauterizing tissue samples are also not recommended, for similar reasons.

Deep Shave Biopsy (Saucerization)

This biopsy technique is like a superficial shave biopsy, but is used to obtain a deeper specimen and is often used when biopsing lesions suspected of being melanoma.

    • Description: Saucerization procedures are performed in the doctor’s office under local anesthetic. A doctor uses a surgical blade to “scoop out” the suspicious lesion, and a sufficient depth of skin beneath it to be able to stage the cancer.
    • What you’ll feel: While it is a surgical procedure, you won’t experience much pain. You’ll feel a needle stick and a little burning with some pressure when you receive the anesthetic. But as it takes affect you won’t feel any pain from the surgery as the doctor removes a portion of the lesion. The wound is not usually sewn closed, but is left to heal from the inside out.
    • How long does it take?

The procedure usually takes less than 10 minutes.

  • Afterwards: Some over the counter pain medication (your doctor should tell you which to take) will ease any pain coming from the site of the surgery.

 

What to Ask Your Doctor Before a Biopsy

You may find it helpful to print out these questions and bring them with you to your next doctor’s visit.

  • What information do you hope to gain from the biopsy?
  • What is the likelihood that the biopsy will establish a diagnosis?
  • Can the diagnosis be established by any other methods?
  • How is the biopsy done?
  • Is the procedure painful? Is a local or general anesthetic involved?
  • How safe is the biopsy procedure?
  • Can the biopsy be performed in your office or must the procedure be done in a hospital?
  • Will you be removing the entire lesion or a part of the lesion? Why?
  • How many samples will be removed?
  • How large is the tissue fragment to be removed?
  • How long will the procedure take? Can I go about my normal daily activities afterward?
  • Will I have pain or scarring afterward?
  • Will I need stitches?
  • How do I take care of the biopsy site?
  • What should I do if I think I have an infection?
  • What does an infection at a biopsy site look like?
  • Are there any complications that might arise as a result of the biopsy procedure? If complications develop, what should I do or whom should I contact?
  • Who will interpret the biopsy?
  • How long will I wait until a result is available?
  • How will I be informed about the result of the biopsy?

Please keep me informed.

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