Biopsy: What to Expect
The only way to confirm or
exclude the presence of skin cancer is with a biopsy. A biopsy is a
diagnostic procedure that involves surgically removing the suspected
tumor, or part of it, in order to microscopically examine the
tissue. The majority of biopsies performed to diagnose skin cancer
involve minor surgery that can be performed under local anesthesia
in a dermatologistís office or medical clinic. This type of biopsy
should not provoke undue anxiety as the discomfort and risks are
minimal. The following explains what to expect.
Step 1: Remove the Tissue
Tissue from the suspect lesion is surgically removed so that it can
be microscopically examined when a dermatologist:
The biopsy is usually performed in a
dermatologistís office or outpatient setting. Before the procedure,
the patient is given a local anesthetic unless medical reasons
necessitate another type of anesthesia. A local anesthetic provides
numbness directly to the tissue. The physician performing the
procedure will explain the reason for the biopsy, the type of biopsy
to be performed, and how the procedure will be performed.
One of four types of biopsies will be performed, and the type is
determined in large part by the size and location of the lesion:
Excisional biopsy: Commonly used to remove a tumor suspected
to be skin cancer, an excisional biopsy consists of removing the
entire lesion along with a margin (section of skin that appears to
be unaffected). The wound created by a small excisional biopsy may
not require treatment. In some cases, stitches, a skin graft, or a
skin flap are needed to treat the wound.
Incisional biopsy: During this biopsy, only a portion of the
lesion is removed. This procedure is considered when a lesion is
large or the location requires maximum preservation of tissue (such
as on a hand or foot). A portion of the lesion may be removed by
using a scalpel; a hollow, circular scalpel-like medical instrument
called a ďpunchĒ (punch biopsy); or a razor (shave biopsy). An
incisional biopsy generally is not used to remove a suspected
melanoma unless the suspicion for melanoma is low, the lesion is
large, or an excisional biopsy is impractical.
Nail bed biopsy: When a dermatologist suspects that melanoma
may be present under a nail, a nail bed biopsy is performed. During
this procedure, part or all of the fingernail or toenail is removed
and an excisional or incisional biopsy is performed on the suspect
Needle biopsy: This procedure is rarely used to remove skin
tissue. Rather, it is used to obtain a sample from an internal
organ, lymph node, or subcutaneous (beneath the skin) tissue to
determine if the skin cancer has spread. To perform the procedure, a
surgeon or other specially trained physician, inserts a small,
hollow needle, which is guided by an X-ray or other imaging
technique, into the area.
After the tissue is removed, the patient should be told how long it
will take to get the results.
Step 2: Examine under a Microscope
After the tissue is surgically removed, it is prepared for
microscopic examination by one of these methods:
Permanent sections: This preparation is done in a pathology
lab. After fixing, the tissue is placed in a paraffin block, sliced
into thin sections, and stained with special dyes that aid
microscopic examination. This process may take up to 48 hours.
Patients should request that a dermatopathologist examine the
removed tissue. A dermatopathologist is a physician who has received
specialized training in both dermatology and pathology and is
considered an expert in the diagnosis of skin conditions. During the
microscopic examination, the dermatopathologist will determine if
cancer cells are present and if so which kind. If an excisional
biopsy was performed, the dermatopathologist also should be able to
determine how deeply the cancer has penetrated the skin.
Frozen sections: This may be done in a pathology lab or
dermatologistís office (generally only available in offices in which
the dermatologist is a Mohs surgeon). Once frozen, the tissue is
sliced into thin sections and stained with special dyes that aid
microscopic examination. Although creating frozen sections is
quicker, it is not appropriate in all cases.
Regardless of the method used to prepare the tissue, a report is
written to document the findings after thorough microscopic
Step 3: Discuss the Findings
Waiting for the test results is probably the most difficult part of
a biopsy. If the patient does not hear from the dermatologist within
the specified timeframe, a follow-up call should be made.
Once the results are received, the dermatologist or dermatologic
surgeon will discuss the findings with the patient and explain what
the findings mean. Patients should feel free to ask questions and
may wish to request their own copy of the pathology report.
When skin cancer is detected, the report will indicate which type of
skin cancer is present and contain some of the information necessary
to estimate the cancerís stage. The report also may recommend that
additional excisions or biopsies be performed or that evaluation of
the lymph nodes and internal organs be performed to check for
Based on the test results, the dermatologist will confer with the
patient to plan any further studies or necessary therapy. Some types
of skin cancer and those in advanced stages may require referral to
a cancer specialist, such as a medical or surgical oncologist or
content solely developed by the American Academy of Dermatology