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If your dermatologist cannot rule out the possibility of skin cancer, a biopsy will be performed in order to make a diagnosis. This involves removing part or all of the suspicious mole for examination by a pathologist. You will be given a local anesthetic so the procedure is nearly painless. There are three types of biopsies performed for diagnosis of skin cancer. One of these, the shave biopsy, should not be used if melanoma is suspected.

The Excisional Biopsy

In an excision biopsy, the entire suspect area is removed. A local anesthetic is injected. Then the entire lump, spot, or sore is removed, going as deep as necessary to get the entire area. The incision is then closed with stitches. Bleeding is controlled by pressure. If a large area is biopsied, a skin graft may be used to cover it.

The Punch Biopsy

A punch biopsy is also sometimes used by a dermatologist to collect a tissue sample from a suspected mole. After a local anesthetic is injected, a biopsy punch, which is basically a small (3 or 4 mm in diameter) version of a cookie cutter, is used to cut out a cylindrical piece of skin. The hole is typically closed with a suture and heals with minimal scarring.

The Shave Biopsy

In a shave biopsy, only the outer protruding part of the suspect mole is removed. A local anesthetic is injected. Then a sharp scalpel is used to cut off the top part of the mole protruding above the skin.

With all biopsies where melanoma is a possibility, care must be taken to ensure that the full thickness of the lesion is included in the biopsy specimen because treatment and prognosis is critically dependent on accurately assessing the depth and level of invasion of the lesion into the lower layers of skin. For this reason, a shave biopsy should not be performed because this technique fragments the lesion, preventing accurate assessment of the depth and thickness of the melanoma.

The Biopsy Report

After the biopsy, the dermatologist will send the collected specimen to a pathologist who will prepare a biopsy report for your physician describing the results of the examination of the biopsy specimen. You can and should request a copy of this report as it contains valuable information that you may need to refer to in the future.

Another word of caution here. The pathological diagnosis of melanoma is notoriously difficult. For this reason, it is generally recommended that the pathology test for a suspicious mole be done by a dermapathologist as they receive specialized training in the detection of skin tumors.

The following helpful guide to the biopsy report that the dermapathologist will prepare for your physician is adapted from The Biopsy Report: A Patient's Guide by Dr. E. Uthman. The sections not pertinent to melanoma patients have been deleted but the document is otherwise unaltered.