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Concept
Skin biopsy
Summary
Skin biopsy is a biopsy technique in which a skin lesion is removed to be sent to a pathologist to render a microscopic diagnosis. It is usually done under local anesthetic in a physician's office, and results are often available in 4 to 10 days. It is commonly performed by dermatologists. Skin biopsies are also done by family physicians, internists, surgeons, and other specialties. However, performed incorrectly, and without appropriate clinical information, a pathologist's interpretation of a skin biopsy can be severely limited, and therefore doctors and patients may forgo traditional biopsy techniques and instead choose Mohs surgery. There are four main types of skin biopsies: shave biopsy, punch biopsy, excisional biopsy, and incisional biopsy. The choice of the different skin biopsies is dependent on the suspected diagnosis of the skin lesion. Like most biopsies, patient consent and anesthesia (usually lidocaine injected into the skin) are prerequisites.
A shave biopsy is done with either a small scalpel blade or a curved razor blade. The technique is very much user skill dependent, as some surgeons can remove a small fragment of skin with minimal blemish using any one of the above tools, while others have great difficulty securing the devices. Ideally, the razor will shave only a small fragment of protruding tumor and leave the skin relatively flat after the procedure. Hemostasis is obtained using light electrocautery, Monsel's solution, or aluminum chloride. This is the ideal method of diagnosis for basal cell cancer. It can be used to diagnose squamous cell carcinoma and melanoma-in-situ, however, the doctor's understanding of the growth of these last two cancers should be considered before one uses the shave method. The punch or incisional method is better for the latter two cancers as a false negative is less likely to occur (i.e. calling a squamous cell cancer an actinic keratosis or keratinous debris). Hemostasis for the shave technique can be difficult if one relies on electrocautery alone.
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Related concepts (9)
Actinic keratosis
Actinic keratosis (AK), sometimes called solar keratosis or senile keratosis, is a pre-cancerous area of thick, scaly, or crusty skin. Actinic keratosis is a disorder (-osis) of epidermal keratinocytes that is induced by ultraviolet (UV) light exposure (actin-). These growths are more common in fair-skinned people and those who are frequently in the sun. They are believed to form when skin gets damaged by UV radiation from the sun or indoor tanning beds, usually over the course of decades.
Mohs surgery
Mohs surgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat both common and rare types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination dictates the decision for additional tissue removal. Mohs surgery is the gold standard method for obtaining complete margin control during removal of a skin cancer (complete circumferential peripheral and deep margin assessment - CCPDMA) using frozen section histology.
Cutaneous squamous-cell carcinoma
Cutaneous squamous-cell carcinoma (cSCC), or squamous-cell carcinoma of the skin, also known as squamous-cell skin cancer, is, with basal-cell carcinoma and melanoma, one of the three principal types of skin cancer. cSCC typically presents as a hard lump with a scaly top layer, but it may instead form an ulcer. Onset often occurs over a period of months. Cutaneous squamous-cell carcinoma is more likely to spread to distant areas than basal cell cancer.