A skin biopsy is removal of a piece of skin (all or part of a lesion, part of a rash, etc). The piece of skin is then sent to a dermatopathology lab, where it is made into a slide and read by a dermatopathologist. A dermatopathologist is a pathologist who specializes in reading skin biopsies. The pathology report tells us what is going on in the skin. If the biopsy shows skin cancer, further surgery is often required to completely remove the skin cancer. A punch biopsy is done with a small round knife and requires sutures (stitches) to close the skin. The sutures will be removed in one or two weeks, depending on the body site. A shave biopsy is done with a blade to shave off a small piece of skin. Your doctor will decide which type of biopsy is needed depending on the lesion. All biopsies are done with local anesthesia and performed by your physician.
An excision is the complete removal of a skin lesion. Depending on the size of the lesion, this is usually a longer procedure than a biopsy. Excisions are done in the office with local anesthesia.
Who does the procedure?
The physicians do all procedures in our office. Depending on the site and nature of the lesion, we may refer you to another doctor for the procedure. We are lucky to have excellent working relationships with a select group of Mohs and plastic surgeons in the area. Our office will coordinate your care with these specialists if needed.
Mohs Micrographic Surgery
Our physicians may send you to a specialized Mohs surgeon for treatment of a skin cancer. This process was developed by Dr. Fred Mohs in the 1930’s. In this process, the skin cancer is removed in stages. Immediately after each stage is removed, the samples are mapped and slides are reviewed to see if there is any residual tumor. If the cancer is still present, only those areas are removed in the next stage. In this way, complete removal of the skin cancer is achieved with minimal removal of normal surrounding skin. For this reason, Mohs surgery is called a “tissue-sparing” technique. This process can take several hours, with “rest” times between stages. While the patient relaxes in the waiting room, the Mohs surgeon is preparing and reviewing the slides. Once the tumor has been completely removed, the wound is repaired.
Any surgery of the skin will result in a scar. Our goal is always to minimize scarring and to achieve the best cosmetic result possible. Scars naturally improve with time. Various techniques are used to treat scars, including laser, cortisone injections, massage and silicone gel sheeting.