Skin biopsy - Small <1cm

Biopsy

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Histology of skin lesions.

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Skin Biopsy - Small (<1cm)

Why is it done?
- Diagnosis of suspicious skin lesions, moles, or growths that may be melanoma or other skin cancers
- Evaluation of inflammatory or infectious skin conditions such as lichen planus, psoriasis, or fungal infections
- Assessment of atypical skin manifestations or rashes of unknown etiology
- Investigation of suspected autoimmune or connective tissue diseases with cutaneous involvement
- Evaluation of pigmented lesions with concerning features (asymmetry, irregular borders, color variation)
- Typically performed when clinical examination or dermoscopy findings are inconclusive and histopathological diagnosis is needed
Normal Range
- Normal Result: Benign skin tissue with no evidence of malignancy, inflammation, or infection. Normal histology includes intact epidermis, normal dermal collagen, and appropriate distribution of melanocytes.
- Negative Result: No malignant cells, atypical features, or significant pathological changes detected
- Positive Result: Presence of malignant cells, dysplasia, or specific pathological diagnosis (e.g., melanoma, squamous cell carcinoma, basal cell carcinoma, or inflammatory condition)
- Units of Measurement: Histopathological diagnosis reported descriptively with microscopic findings and classification according to standardized pathology nomenclature
Interpretation
- Benign Findings: Nevi (moles), seborrheic keratosis, dermatofibroma, or other common benign skin lesions. No follow-up biopsy typically needed unless clinical appearance changes.
- Atypical/Dysplastic Findings: Dysplastic nevus or actinic keratosis with cellular atypia. Requires closer clinical monitoring and may warrant re-excision or repeat biopsy if margins are inadequate.
- Melanoma (In Situ or Invasive): Malignant melanocytic lesion. Requires wide local excision, Mohs micrographic surgery, or other definitive surgical treatment with possible staging studies and systemic therapy.
- Squamous Cell Carcinoma (SCC): Non-melanoma skin cancer. Treatment depends on grade and depth; may include re-excision, Mohs surgery, radiation, or systemic therapy.
- Basal Cell Carcinoma (BCC): Most common skin cancer. Low risk of metastasis but requires complete removal through re-excision or Mohs micrographic surgery.
- Inflammatory Conditions: Specific diagnosis of psoriasis, lichen planus, lupus, or other dermatologic conditions guides targeted treatment.
- Infectious Findings: Detection of fungal organisms, bacteria, or viral inclusions; special stains may be used (PAS, GMS, AFB) for organism identification.
- Factors Affecting Results: Adequate tissue sampling, proper fixation, specimen orientation, sun exposure history, patient age, anatomical location, prior treatments, and immunosuppression status
Associated Organs
- Primary Organ System: Integumentary system (skin), the body's largest organ serving as a protective barrier
- Conditions Associated with Abnormal Results: Melanoma, basal cell carcinoma, squamous cell carcinoma, actinic keratosis, psoriasis, lichen planus, pemphigus vulgaris, bullous pemphigoid, lupus erythematosus, mycosis fungoides, dermatitis, tinea, candidiasis, and bacterial infections
- Diseases This Test Helps Diagnose: Skin malignancies, pre-malignant lesions, autoimmune blistering disorders, inflammatory dermatologic conditions, infectious skin diseases, and systemic diseases with cutaneous manifestations
- Potential Complications: Detection of malignancy requires urgent treatment; systemic spread of melanoma can affect lymph nodes, lungs, liver, brain, and bones; recurrent skin cancers may develop; infection at biopsy site is rare but possible
- Systemic Implications: Skin findings may indicate systemic lupus erythematosus, sarcoidosis, lymphoma, or other systemic conditions requiring comprehensive workup and specialist involvement
Follow-up Tests
- For Confirmed Melanoma: Sentinel lymph node biopsy, chest X-ray, CT scan, PET scan, lactate dehydrogenase (LDH) level, immunohistochemistry for tumor markers (S100, Melan-A)
- For Confirmed Non-Melanoma Skin Cancer: Repeat excision or Mohs micrographic surgery, imaging studies if invasion is significant, baseline skin examination to rule out other lesions
- For Dysplastic Nevi: Regular clinical skin surveillance every 3-6 months, total-body photography, dermoscopy, possible repeat biopsy of changing lesions
- For Inflammatory Conditions: Serologic testing (ANA, complement levels), direct immunofluorescence, patch testing, indirect immunofluorescence, autoantibody panels as indicated
- For Infectious Findings: Fungal culture, bacterial culture, KOH preparation, viral PCR, or additional histochemical stains as needed for organism identification
- Monitoring Frequency: Benign findings: annual full-body skin examination; dysplastic/atypical: every 3-6 months; melanoma: every 1-3 months initially, then quarterly to annually based on stage; non-melanoma skin cancer: annual surveillance
- Complementary Imaging/Testing: Dermoscopy, reflectance confocal microscopy (RCM), optical coherence tomography (OCT), total-body photography, genetic testing (BRAF, KIT mutations) for advanced melanoma
Fasting Required?
- Fasting: No - Fasting is not required for skin biopsy procedures
- Patient Preparation: Clean the area with soap and water; avoid lotions, makeup, or sunscreen on the biopsy site; wear loose, comfortable clothing; arrive with skin clean and dry
- Medications to Avoid/Inform Provider: Blood thinners (warfarin, dabigatran, rivaroxaban, apixaban) - may need to be held temporarily; NSAIDs and aspirin - may increase bleeding risk; report all medications to provider before procedure
- Special Instructions: Inform provider of keloid tendency, allergy to local anesthetics, or immunosuppression; small bandage will be applied post-procedure; keep site clean and dry for 24 hours; avoid strenuous activity for 48 hours; results typically available in 5-10 business days

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