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Biopsy
Skin cancer can't be diagnosed merely by looking at it. If a mole or pigmented area of the skin changes or looks abnormal, your doctor may choose to biopsy the mark, taking a tissue sample for a pathologist to examine. Suspicious areas should not simply be shaved off or cauterized (destroyed with a hot instrument, an electrical current, or a caustic substance). A biopsy should be performed first to determine if the area is malignant.
Several techniques are used to perform skin biopsies. For skin cancer, your doctor will most likely use a technique known as local excision, in which the entire suspicious area is removed with a scalpel under local anesthetic. Depending on the size and location of the suspicious area on your body, you may have this type of biopsy done in a doctor's office or possibly as an outpatient at a hospital. Your doctor will put in stitches to close the excision and cover the area with a bandage.
Some doctors use other biopsy techniques called punch biopsies or shave biopsies. In a punch biopsy, the doctor uses a tool to punch through the suspicious area and extract a round cylinder of tissue. In a shave biopsy, the doctor simply shaves off a piece of the growth. Both of these types of biopsies are usually done in a doctor's office. If the tissue is malignant, further excision will be necessary.
The sample of skin is sent to a pathologist, who looks at the tissue under a microscope to check for cancer cells. Your tissue may be judged normal or abnormal. Abnormal results may include benign growths such as moles, warts, and benign skin tumors or may mean a diagnosis of squamous cell carcinoma, basal cell carcinoma, or melanoma. Because melanoma can be hard to diagnose, patients should consider having their biopsy sample checked by a second pathologist.
As with any time the skin is cut, there is a small risk of infection after a biopsy. You should call your doctor if you have a fever, an increase in pain, reddening, or swelling at the infection site, or continued bleeding. If your skin usually scars when injured, the biopsy may leave a scar. For this reason, a biopsy on the face might be better performed by a plastic surgeon or dermatologist who specializes in techniques that reduce scarring. If a large area is biopsied, a skin graft may be required to cover it.
Before you have a skin biopsy, you should tell your doctor what medications you are taking, including anti-inflammatories, which may make your biopsy look different to the pathologist, or blood thinners like Coumadin or aspirin, which could cause bleeding problems.
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