Biopsy is one of the most important diagnostic tools in medicine in general and specifically in dermatology.
Skin biopsy is a medical procedure in which a small piece of skin tissue is surgically taken to be further examined. This examination plays a crucial role in diagnosing many dermatological conditions, whether it's ruling out malignancy or diagnosing dermatological diseases in general.
When is a biopsy necessary?
In dermatological practice, biopsy is used not only to confirm malignancy but also to assist in the diagnosis of any dermatological problem.
Here are times when the clinical presentation is very atypical or unusual, but also the opposite is very common, leading to several conditions.
In such cases, taking a skin tissue sample and examining it at a cellular level is what can help make an accurate diagnosis and, consequently, provide appropriate treatment.
For example, it may be warranted when we suspect skin cancer, suspicious moles that may have changes, be new, or cause symptoms in the patient, persistent rashes that persist despite treatment efforts, chronic conditions that have never been precisely diagnosed. These are some examples in which the dermatologist may recommend a biopsy.
The importance of identifying the biopsy site
Unlike laboratory tests where the entire process is carried out in diagnostic centers, the skin tissue biopsy is performed in the doctor's office by the dermatologist to select the correct site from which the biopsy will be taken.
The choice of site is particularly important. Locating the lesion, its shape, its age in appearance, the exact cutting location are critical factors. If not done correctly, it will not be possible to draw the right conclusion. Additionally, these factors vary depending on the possible clinical diagnoses of the dermatologist. Depending on which diseases the doctor suspects, biopsy rules may differ.
Procedure for taking a biopsy
After the appropriate site is selected, local anesthesia is administered via injection at the exact point on the skin to be removed, ensuring that the entire procedure is completely painless.
There are three main techniques for skin biopsy: punch biopsy, shave biopsy, and surgical biopsy.
• In punch biopsy, which is the most common technique, a cylindrical piece of skin, approximately 4 millimeters or less in diameter depending on the area, is removed. After removal, any small defect is closed with sutures which are removed after a few days.
• In shave biopsy, only the most superficial layers of skin are removed, and the wound is left to heal without sutures. It is usually indicated for superficial skin lesions or areas of the body where the skin is very thin.
• In surgical biopsy, a larger piece of skin is removed both in terms of extent and depth, and sutures are always required afterward. It is necessary when our diagnostic problem is located deeper within the skin.
The wounds in all three cases heal quickly with basic home care by the patient for a few days.
After the biopsy is taken, the tissue sample is preserved in special materials, which may vary depending on the clinical suspicion of the dermatologist, so that appropriate stains can be applied and suitable techniques used by the pathologist, such as immunohistochemistry and immunofluorescence. The pathologist, after processing the tissue, examines it under the microscope and based on the type of cells found and their location, reaches conclusions.
Diagnostic Approach
It is very important to emphasize the significance of diagnostic suggestions from the dermatologist. In addition to the tissue sample, the pathologist receives a report from the dermatologist with the patient's history regarding the specific skin condition being investigated, such as when it started, if it has symptoms, and how it behaves over time. The clinical appearance of the lesion is described, and the clinical suggestions by the dermatologist are provided, meaning their clinical suspicion based on what they see. Additionally, the report is supplemented with information about the patient's overall health, other diseases, medications, and family history. Thus, the pathologist knows more accurately in which diagnostic context to proceed, and considering all this information, reaches their final report.
This final report, combined with the clinical dermatological picture, leads the dermatologist to the final diagnosis.
What one should remember about skin biopsy
Skin biopsy is a simple, painless, safe, and relatively short procedure performed in the doctor's office.
It is very important that 10-15 days before taking the tissue sample, no therapeutic creams or other substances have been applied to the area that may alter the histological appearance of the lesion and lead to incorrect conclusions.
The results of the examination take a few days to come out.
Importance of skin biopsy
The immediacy in taking the biopsy is one of the great advantages of dermatology compared to other specialties where this process is more invasive and often painful.
There are hundreds of diseases in dermatology that can be expressed with only a few clinical images on the skin. Biopsy provides us with the opportunity for a safe diagnosis quickly and effectively, and therefore for the most effective treatment.
Furthermore, it is a crucial diagnostic tool for the diagnosis of skin cancer. Early diagnosis of skin cancer is truly vital, and skin biopsy allows us to intervene and substantially assist in the course of our patients' health in the least invasive way possible.