Biopsy of Skin Lesions

Biopsy of Skin Lesions

You’re receiving this handout becausewe’veperformeda biopsy onalesionin order to ruleoutatypical cells or possibly evenskincancer.

Woundcareis fairly straightforward.Justcleansethesite(s)1-2x/daywithsoapandwater andcover withdressingandbandage.Fordressing,we usuallyaskthatyou useVaselineor plain petroleumjelly. Thereasonis thatweoccasionally seepatientswho experiencean allergicreactionto Neosporinor bacitracin, butifyou’veusedthemin the pastwithout problem,thenit’s fineto use either insteadof Vaseline.

After youleavetoday,we willsendthe biopsy sample to thelab for evaluation. Theresults are typically availablewithin several days.Wewill either discuss thoseresults withyouwhen you comebackfor follow-uporwe will call youwiththe results if no follow-uphas beenscheduled.

NOTE:Please keep inmind that a biopsyissimplya test.Ifthe lab determines that the

lesioncontains abnormal or cancerous cells, additionaltreatmentmaybe needed in order to ensure that noharmful cellsremain.

The most common ‘atypical’lesionsare:

Actinic keratoses(AKs)areoftenreferredto as ‘pre-cancers’sincetheycarry anincreasedrisk of turninginto a squamouscell carcinoma. Theydon’t turnintomelanoma.Overall,it’s a goodthingfor thelabto tell us thatalesionis ‘just’anactinic keratosis sinceit means thatthe lesionhasn’tyetturnedinto askin cancer.Treatmentof these usually consistsof freezing withliquidnitrogenor sometimesatopical creamcanbeprescribed.

Basal cell carcinoma(BCC)is sometimesreferredto asthe ‘bestkindof skin cancertohave’ sincetheydon’t tend to go too deepor ‘spread’to otherareas.Althoughthey don’tspread,if left untreatedtheycan eventually breakdowntheskin and destroytheunderlyingand surroundingtissue.If caughtin the early ‘superficial’stage,they canbe treatedwitha cream whichactslikeatopical formof chemotherapy.MostBCC,though,requireexcision or a procedure calledelectrodesiccationandcurettage –a procedureinwhich the BCCis shavedoff, remaining cells are ‘scraped away’, andthebaseis electrocauterized (burned).

Squamous cell carcinoma(SCC)is theother‘non-melanoma’ typeof skincancer. Although theyhaveapotentialto spread,it’s veryrarefor themto do so.Themorecommonconcernis that,similarto BCC,they can damagethe underlyingandsurroundingtissueif leftuntreated. Treatmentoptionsaresimilarto those described forBCC.

Dysplastic or ‘atypical’ nevusis thetermgivento a molewhichisatypicalbut not yetmelanoma.When thelabprovides this diagnosis, theywill classifythe degreeof atypia.A nevus whichisclassifiedas ‘mildly’ dysplastic/atypicalis exhibitingminimal irregularityandposes very low riskof ever turninginto a melanoma. Thosewhichare‘moderately’or ‘severely’ dysplastic/atypicalare moreso and,althoughstill not yetmelanoma,carry agreaterriskof eventually turninginto skincancer.Whentreatmentis necessary, dysplastic/atypical nevi require eithershaveremovalor excision.

Melanoma is the mostwell-knowntypeof skin cancer.Becausetheyrepresentcancerof the pigment cells (melanocytes),theytypically presentas adarkspot whichkeeps growingand changing.Although melanomasareactually theleast commontypeof skincancer,they’re potentiallythe mostserious.If caughtin thevery earliest stages,theysimply need to be excisedintheoffice withno furthertreatment necessaryother thanregular re-evaluationand skinexams.If/whenmelanomasare diagnosedas beingalittledeeper,theydo carry therisk of metastasizing–althoughmostdonot.Becauseof thisrisk,though,it maybe necessaryto not only excise, butalso performanevaluationof thelymph nodesjustto besafe.Exactly whichtreatmentapproachis necessaryfor melanoma depends on many factors – includingthe depth and stagingas determinedbythe pathologist.