What biopsy methods are used for skin cancer?

Dr. Doris Day, MD
A skin biopsy is a quick and relatively painless procedure. Here’s what it entails:  

• In the office the procedure is first explained as to what and why it is being done. An informed consent is usually signed

• Next the area to be biopsied is cleaned with an alcohol wipe and Betadine.

• The biopsy site is then anesthetized using Lidocaine with or without epinephrine, depending on the site. This is the only part of the procedure that has potential to be painful. By painful I mean a pinch and a sting that lasts for about three seconds. After this, there is no pain at all.

• The site is now ready for the biopsy. The doctor uses a scalpel, which is a sharp blade, to remove the lesion either in part or in its entirety and places the specimen in a bottle of formalin. Stitches are not usually used for these procedures.

• After this, antibiotic ointment and a Band-Aid are applied and you are ready to go back to your regular activities, unless otherwise instructed.
• At home, you will apply an antibiotic ointment such as Bacitracin or Neosporin, or you may be instructed to use a bland ointment such as petrolatum jelly and change the band-aid daily for about one week. It is a good idea to keep the site covered for the first few days after the procedure for better healing. Crusting of the site will slow the healing process.

• The specimen is sent to the lab where it is processed, stained, and then examined under a microscope by a dermatopathologist (a pathologist that only looks at specimens from the skin).

• A report is sent back to the dermatologist over the next few days to a week with the results of the exam.

• Sometimes more than one biopsy needs to be done to make a definitive diagnosis.
Dr. Ellen Marmur, MD

The following biopsy methods are used for skin cancer:

Shave: This is a minimally invasive biopsy. We use a flexible surgical blade to do a very superficial, paper-thin section of the lesion. (For lack of a better image, this is a bit like a cheese slicer that cuts a perfect, sheer circle of Parmesan.) This slice of tissue provides the pathologist a bigger sample to read.

Curette: This method employs a tool with a small open circle on one end that is sharp on one side. One limitation is that curetting might provide a smaller specimen. Sometimes the pathologist can't get a sufficient view of the smaller sample of skin.

Punch: This technique uses a device that has a circular open tip with a sharp edge (it looks similar to a ballpoint pen). The doctor presses the punch into the skin and swivels it from side to side, removing a small but deep cylindrical core of tissue (rather than just the top part of skin). So there is a layer-cake specimen with the epidermis on top, the dermis in the middle, and fat underneath that. Because this enables the pathologist to read the depth of a lesion, a punch biopsy is done on a pigmented lesion that's suspected to be melanoma (where depth is the most important characteristic). Punch biopsies are limited to an area of skin that's only six to eight millimeters in diameter; for a larger lesion the doctor would probably opt for an excision.

Excision: The entire tumor, including the borders of healthy tissue that surround it, is surgically removed. Although this is obviously the most invasive biopsy procedure, it is the best way to test for melanoma and excise the abnormal area at the same time. It is usually outpatient surgery done with a local anesthetic. The excision plus the stitches afterward take about thirty minutes, although a larger lesion obviously takes longer.

Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

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Simple Skin Beauty: Every Woman's Guide to a Lifetime of Healthy, Gorgeous Skin

What if a leading dermatologist just happened to be your best friend and you could ask her anything? DR. ELLEN MARMUR, a world-renowned New York City dermatologist, answers all your questions with...

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.