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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.