NCCN Guidelines for Patients
Part 2: Overview of cancer tests
2.2 Tumor tissue tests
To confirm if you have melanoma, a sample of tissue
must be removed from the concerning spot on your skin
to test for cancer cells with a microscope. This is called a
biopsy. Based on the physical and skin exam, your doctor
may perform a skin biopsy. For a skin biopsy, your doctor
will remove part of your skin in order to examine it with a
microscope. There are many types of biopsies used for
melanoma. The type of biopsy you will have depends on
the size and location of the concerning spot (lesion) on
Excisional skin biopsy
An excisional skin biopsy removes the entire lesion and
a small amount of normal-looking skin around the edge
using a surgical knife.
Incisional skin biopsy
An incisional skin biopsy removes only part of the lesion
with a surgical knife. This type of biopsy may be done for
a very large lesion. It may also be used for a lesion that’s
in a place where it can’t be easily removed such as your
face, ear, palm of your hand, or sole of your foot.
A punch biopsy uses a sharp hollow device to remove
a small but deep sample of both skin layers (Figure 7).
This kind of biopsy may be better for very large lesions or
certain areas of the body. These areas include the face,
ear, finger, toe, palm of the hand, or sole of the foot.
A shave biopsy removes the epidermis and the top part
of the dermis. A shave biopsy is usually not done if your
doctor thinks the melanoma has grown into the dermis.
This is because it wouldn’t tell how deep the cancer has
grown. A shave biopsy is often used to remove moles that
look normal and for skin diseases other than melanoma.
Before a biopsy, your doctor will numb your skin with
local anesthesia. Tell your doctor if you’ve had any
reactions to anesthesia in the past. With local anesthesia,
you’ll feel a small needle stick and a little burning with
some pressure for less than a minute. Then, there will
be a loss of feeling in that area for a short time. You may
feel a little pressure during the biopsy, but no pain. After
the biopsy, your doctor may close the wound and apply a
bandage. There are usually no side effects, but scars can
form after some biopsies.
Figure 7. A punch biopsy
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