Many medical conditions, not only cases of cancer, may be diagnosed
by removing a sample of tissue for lab examination. This procedure is
called a biopsy. Any organ in the body can be biopsied using a variety
of techniques. After the doctor obtains the skin biopsy specimen, it
is sent for examination to another doctor, the dermatopathologist, who
prepares a written report with information designed to help manage the
condition properly.
TYPES OF BIOPSIES
Excisional biopsy: The entire lump or tumor is removed
(excised).
Incisional biopsy: A portion of the lump is removed surgically.
This type of biopsy is most commonly used for tumors of the skin to
distinguish benign conditions and diagnose cancers and other tumors.
This can be done by "punch", "shave" or "currette"
methods.
A "shave" slices a surface portion off with a blade. A
"curette" scrapes off the surface. These are often done to
remove a small growth and confirm it's nature at the same time.
A "Punch" biopsy is typically used by dermatologists to
sample skin rashes and small masses. After a local anesthetic is
injected, a biopsy punch, which is basically a small (1 to 4 mm in
diameter) version of a cookie cutter, is used to cut out a cylindrical
piece of skin. The hole may be closed with a suture and heals with
minimal scarring.
Fine needle aspiration: A needle no wider than that typically used
to give injections is inserted into a lump (tumor), and a few cells
are drawn up (aspirated) into a syringe.
SPECIMEN PROCESSING
After the specimen is removed from the patient, it is processed
into thin, stained slices mounted on a glass slide. Frozen sections, a
more rapid technique allows one to have within a few minutes of
removing the specimen. Unfortunately, the quality of the sections is
not nearly as good as those of the regular ("permanent")
slides. This is often done when growths are removed in a hospital or
by a Mohs surgeon.
PATHOLOGIC EXAMINATION
This is the interpretation of the slides. The report produces has
three main parts: the gross description (how the specimen as it looks
to the naked eye, and it's size and shape), the microscopic exam (the
appearance of the cells under the microscope) and the diagnosis (the
"bottom line" of the report).
Many HMO labs that work for volume do not include much of this in
the written report. In such a case, the diagnosis is considered to
speak for itself. The biopsy test is not an exact science. In cases of
difficult or unusual problems, second opinions can be helpful. They
are rarely of any value, however, with common problems like Basal cell
cancer, keratosis or psoriasis. For further information on you
diagnosis, discuss your report with Dr. Rosen