Diagnosing BCC – Biopsy


Medical History and Physical Examination

One of the first steps a clinician takes when evaluating patients for BCC is to take a detailed medical history. The patient is asked about his or her symptoms, such as when the lesion first appeared on the skin, if it has changed in size or appearance, and whether it has caused pain, itchiness, or bleeding. During this time, clinicians will also ask patients about their previous exposure to UV radiation and whether there is a family history of skin cancer in order to gauge the patient’s risk for skin cancer. (1)

During the exam, they will likely also check the patient’s lymph nodes to identify any potential sites of metastases. If extensive disease is suspected, imaging studies may be performed to determine whether there is bone involvement, or deep tissue involvement.


After visually inspecting a lesion in search of characteristic features of BCC, clinicians can rely on dermatoscopy (also known as dermoscopy, epiluminescence microscopy, or surface microscopy) to further refine the differential diagnosis. Dermatoscopy , or the use of a magnifying device that emits polarized light to examine the skin, can detect reliable and robust diagnostic parameters

Figure 10. Dermatoscopy of a nodular BCC.


If the clinician identifies a suspicious lesion during the physical examination, the next step in the diagnostic pathway is a skin biopsy. A skin biopsy is considered a necessary step to confirm a BCC diagnosis. There are several different types of biopsy techniques that may be used.

Shave biopsy

For most nodular and superficial BCC lesions, a shave biopsy that includes the full depth of the lesion is sufficient for an adequate diagnosis.

Punch biopsy

The doctor uses a sharp, hollow instrument to remove the lesion and some normal tissue around it. This type of biopsy may be used for specific areas of the body, such as the face.

Excisional biopsy

In patients with obvious BCC, particularly when it is located in an area where cosmetic outcome is not a priority, an excisional biopsy involving removal of the lesion in its entirety can be performed, with the goal of both histologic diagnosis and definitive therapy

Regardless of the biopsy method chosen, it is critical that adequate tissue is sampled to ensure complete pathologic review.

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1.Cemiplimab BCC Learning System Module 2: Basal Cell Carcinoma Disease State