Getting a Diagnosis

With so many skin conditions to be had, a visual examination is not enough to conclude that a lesion is in fact skin cancer. A mole, growth or lesion may look like a “classic case” of skin cancer and yet be benign. On the other hand, a mole that looks quite normal could be a dangerous melanoma.

Biopsy

A biopsy is the one definitive way to know for sure whether or not there is a cancerous condition present. This is ordinarily covered by insurance as a diagnostic procedure. Having a biopsy done means taking a small sample of tissue for examination under a microscope by a pathologist -– someone highly trained in recognizing cancerous cells. Since cutting away a portion of skin– no matter how small– is painful, you will usually have a local anesthetic for the procedure. There are several methods of obtaining the tissue sample for the biopsy:

• Shave Biopsy: As the name implies, a sharp blade is used to shave off all or part of the suspicious area. This method is generally not used if melanoma is suspected, as thickness is the most important measurement for treatment planning.
• Punch Biopsy: For this type, the doctor uses a circular tool (much like a cookie cutter!) to remove the tissue sample.

• Incisional: A scalpel is used to remove part of a lesion. This method is used in cases where the suspect area is large, or where a tissue-sparing method is preferred, such as on hands, feet, and eyes. This method is not usually used if melanoma is suspected.
• Excisional: A scalpel is used to remove the entire lesion along with a margin of healthy tissue. This type usually requires closure with stitches. Unusually large or oddly placed excisional biopsies may require a skin flap or graft for closure.
• Nail Bed: If the suspicious area is under a fingernail or toenail, at least part of the nail will need to be removed to provide access for an incisional or excisional biopsy to be performed.
• Fine Needle Aspiration: Rarely used to get a skin sample, this method is more likely to be used to obtain a sample from subcutaneous areas below the skin and from lymph nodes.

Questions To Ask Your DoctorHere are some common sense questions to ask the doctor:

• Which type of biopsy is right for me?
• Will this be done in your office or at the hospital?
• Will the biopsy hurt?
• How do I care for the wound when I get home?
• Will there be scarring?
• When will I get the results?
• Is It cancerous?

Waiting for the results is usually more painful than the biopsy. Results can take anywhere from a couple of days to two weeks, depending on doctors’ orders and lab procedures. Your doctor will let you know what time frame to expect. Call your doctor’s office if it has been longer than you expected –- most are very understanding. Your doctor will discuss the pathology report with you, usually in his office. It’s a good idea to take along a trusted friend or family member to act as a listener. People often forget important details when they’re under stress, so two sets of ears are better than one.

Your pathology report will detail whether or not cancerous cells were found, what kind they are, and may include measurements. Sometimes the pathologist will suggest further treatment options. At this point your doctor will spell out his recommendations to you. If any next steps are needed, planning will begin here.