A biopsy is a diagnostic medical test in which a tissue sample is removed for microscopic examination by a pathologist. A biopsy is performed to determine the presence or extent of a disease such as cancer or cirrhosis. Biopsies are performed when physical examination, X-rays or other diagnostic tests indicate the possible presence of a malignancy or other serious disease. Biopsies may be taken from any area of the body in which a lesion, mass or lump is found, and are commonly done on skin, breast, gastrointestinal organs, gynecological or urological tracts.
Types of Biopsy
There are several types of biopsy procedures, each used under different medical circumstances. Depending on the type of biopsy being performed, the patient is either given a local anesthetic, sedation, or anesthesia. In more complex biopsies, CT or ultrasound may be used to provide the doctor with guidance.
- Skin Biopsy: During a skin biopsy, a small blade is used to obtain a sample of skin tissue for examination. In delicate areas, such as the face, Mohs surgery, may be used. In Mohs surgery, each layer of skin is examined to determine the depth of the affected tissue. The Mohs procedure results in minimal or no disfiguration.
- Needle Biopsy: In a needle biopsy, tissue is accessed to extract a small sample of cells for testing at a laboratory. A needle biopsy procedure may be performed either as a fine-needle, which is attached to a syringe, or as a core needle biospy, which is attached to a spring-loaded needle. A needle biopsy is performed to obtain tissue and samples of fluid from muscle, bones or organs.
- Bone Marrow Biopsy: In bone marrow biopsy, a needle extracts bone and bone marrow tissue from the pelvic area. This type of biopsy is used to diagnose blood diseases, such as leukemia or lymphoma.
- Endoscopic Biopsy: During an endoscopy, in which a thin tube is inserted either through the mouth, rectum or vagina, suspect tissue may be collected for biopsy.
- Surgical Biopsy: Open or laparoscopic surgery may be necessary to obtain a sample of tissue for biopsy. Either a piece of tissue or the whole lump of tissue may be removed for examination.
Many moles and birthmarks on the skin are completely benign, and do not pose a health threat. Oftentimes, though, people want these moles removed because they find them unattractive. Types of moles include dysplastic nevi, which can become melanomas. Dysplastic nevi are usually irregular in size, shape, color and border. They can be located on any area of the body, not only those exposed to the sun.
Removal of Moles and Birthmarks
Depending on their depth, location and color, as well as the patient's skin type, age and other factors, treatment for benign but unattractive moles and birthmarks may use the following methods.
- Laser or Pulsed-Light Therapy: Laser or pulsed-light therapy is most beneficial on superficial moles and birthmarks. Laser mole removal is only able to treat flat superficial moles. Moles with deep roots cannot be removed effectively with a laser, and may grow back.
- Surgical Excision: Surgical excision may be considered for deep or raised moles or birthmarks. It may also be recommended for irregular or potentially malignant moles, which will include a biopsy of mole tissue. During an excision, the doctor cuts out the entire mole and surrounding tissue, and stitches the skin closed.
- Surgical Shave: Surgical shaving is recommended for smaller moles and does not require stitches. The doctor numbs the area around the mole and uses a surgical blade to cut around and beneath the mole.
Removal of Irregular Moles
If the doctor believes a mole is irregular and needs to be evaluated further, he or she will either remove the entire mole or a small tissue sample to examine thin sections of the tissue under a microscope. If the mole is found to be cancerous and only a small section of tissue was taken, the doctor will remove the entire mole and a rim of normal skin around it, and stitch the wound closed. Cutting through a suspicious mole will not cause cancer to spread. For patients who receive an early diagnosis, this may be the only treatment needed.
For melanomas that have spread beyond the skin, more aggressive treatment is required. It may include:
- Surgery to remove affected lymph nodes
- Radiation therapy
- Biological therapy to boost the immune system
- Targeted therapy (targets vulnerabilities in cancer cells)
A combination of treatment methods to aggressively target the specific type and severity of cancer that is diagnosed may be recommended.
Dysplastic Nevi Removal
Dysplastic Nevi are atypical moles, which can develop into the skin cancer melanoma. Dysplastic nevi are usually irregular in size, shape, color and border, and can be located on any area of the body, not only those exposed to the sun.
While not every dysplastic nevi will develop into melanoma, patients with these moles are considered at greater risk for developing the condition. In order for a dysplastic nevi to be properly biposied, a sample of the mole tissue will be removed, and examined under a microscope. If the mole is found to be cancerous, the entire mole will need to be surgically excised. During dysplastic nevi removal, the entire mole will be removed, along with surrounding tissue, and the skin stitched closed. Dysplastic Nevi Removal will prevent the melanoma from spreading.
Warts are skin growths caused by viruses. Different warts respond to different treatments; some go away on their own. Salicylic acid products (in the form of drops, gels, pads and bandages) can help self-treatment of many warts by dissolving the keratin protein that makes up the wart and the dead skin above it. Others can be removed via liquid nitrogen freezing or electrical stimulation. Surgery may be recommended for painful or large warts that do not respond to these treatments.