If your doctor or dermatologist finds a suspicious mole, a biopsy, or removal of tissue for examination under a microscope, is taken of the mole. The doctor first numbs the skin with an injection of a local anaesthetic. The entire lesion and a border of normal skin around it should be removed to allow for the most accurate diagnosis by a pathologist or dermatopathologist. A pathologist is a a physician who interprets and diagnoses the changes caused by disease in tissues and body fluids. A dermatopathologist is a specialist doctor that focuses on the study of cutaneous diseases at a microscopic and molecular level.
There are several types of biopsy:
The preferred type of biopsy. The doctor uses a scalpel to remove the entire growth and some tissue around it. This is the most common type of biopsy when melanoma is suspected. A deep shave biopsy, also called ‘saucerization’ or ‘scallop’ biopsy is commonly used to remove an entire mole (lesion) and should not be confused with a superficial shave biopsy.
Sometimes a lesion is very large or in a place where it can’t be easily removed. In these cases, an incisional biopsy is done. An incisional skin biopsy removes only part of the lesion.
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.
Are not recommended for pigmented lesions of the skin for suspected melanoma. A shave biopsy can actually hinder an accurate diagnosis of skin cancer and therefore lead to inadequate treatment culminating in recurrence of skin cancer, possibly spread of the cancer and avoidable death.
In some cases, melanoma may be found somewhere in the body without ever finding a spot on the skin (the original primary). On rare occasions, melanoma skin lesions go away (called, spontaneous regression) on their own without any treatment, but may leave some of their cancerous cells to spread to other parts of the body. Certain rarer forms of melanoma can also start in internal organs (mucosal melanoma for example), and if melanoma has spread widely throughout the body, it may not be possible to tell exactly where it started.
QUESTIONS TO ASK YOUR DOCTOR
You may want to ask your doctor these questions before having a biopsy.
• What type of biopsy do you suggest for me?
• How will you perform the biopsy?
• Where will the biopsy be done? In your office?
• How long does a biopsy take?
• Will the biopsy hurt?
• Will you remove the entire growth?
• What are the risks of a biopsy? What about infection or bleeding?
• Will the biopsy leave a scar? What will it look like?
• Will the tissue be examined by a dermatopathologist?
• When will I find out the results?
• If I have cancer, what are the next steps and who will talk to me about treatment?
Understanding Your Pathology Report
Once the biopsy has been completed, the tissue sample will be sent off to a lab for review by a pathologist. The pathologist’s findings are included in a pathology report. Typical melanoma pathology reports include other information.