When your doctor thinks a lesion or spot on your skin is cancerous, the first step is a skin biopsy. This can be quite scary.
Having a biopsy doesn’t mean you have cancer: plenty of biopsies come back with benign, or negative, results. Even so, the idea that you might have cancer causes worry. Knowing what to expect can help.
A biopsy is when a pathologist examines a sample of tissue to determine if cancer cells are present. Skin biopsies are normally done on an outpatient basis, sometimes right in the doctor’s office. You will receive local anesthesia to numb the area so you won’t feel any pain.
According to the Skin Cancer Foundation, there are three main types of skin biopsies:
_Shave biopsy _: In this type of biopsy, your doctor uses a surgical blade to shave off the top layers of your skin, the epidermis and the outer layer of the dermis. This method is often used if your doctor believes you might have basal cell or squamous cell carcinoma.
Punch biopsy** :** This type of biopsy removes a deeper sample of skin than the shave biopsy. Your doctor will use a tool that resembles a small, round cookie cutter, which is rotated on your skin until it cuts through the epidermis, dermis, and some parts of the subcutis.
_Incisional and excisional biopsies _: Both of these biopsies are done using a surgical knife to make an incision in the skin. During an incisional biopsy, part of the tumor is removed. If you are having an excisional biopsy, your doctor will remove the entire tumor. This is the preferred method if your doctor suspects you have melanoma.
If your biopsy comes back with a diagnosis of cancer, your doctor might suggest additional testing and biopsies of the lymph nodes to determine whether the cancer has spread. These biopsies can be done via a fine needle aspiration, when a syringe is inserted into the tumor to remove fragments, or a sentinel lymph node dissection, which is the removal of the lymph node closest to the tumor.
What happens after removal?
Once your doctor has completed the biopsy, he sends the samples to a laboratory for examination. A pathologist or dermapathologist examines the sample under a microscope. Sometimes, the pathologist needs more information and will conduct further testing, such asimmunohistochemistry (IHC), fluorescence in situ hybridization (FISH), and/or comparative genomic hybridization (CGH).
If the pathologist finds cancer cells, he will use the skin sample to try to determine the tumor thickness and the mitotic rate, which is how many cells are actively dividing. This helps determine the stage of melanoma, which your doctor will use to help plan treatment.
If you have advanced melanoma, the pathologist might test your skin sample for gene mutations, such as the BRAF gene. Today, there are a number of targeted therapies that are based on different gene mutations. Gene testing might also show if early-stage melanoma is likely to spread.
Waiting for biopsy results
When your skin sample is sent to the lab, you are sent home to agonizingly wait for the results. This normally takes one to two weeks. However, according to the American Cancer Society, there are a number of reasons why the result can be delayed, such as additional testing, requesting a second opinion from another expert, or clerical delays. A longer wait doesn’t necessarily signal that there is something wrong.
That doesn’t mean waiting is easy. You might feel scared and confused. You probably have a lot of questions that can’t be answered until the results come back. As difficult as it is, try not to dwell on what is happening or the possible negative outcome. Keep in mind that because you had a biopsy, it doesn’t mean you have cancer. Biopsies are a tool that are used to both _diagnos_e and rule out cancer.
What you can do:* ** Eat right.** Your stomach might be tied up in knots and you might not feel hungry, leading you to reach for junk food and fatty comfort foods, but it is easier to deal with stress if you are practicing good self-care. When you snack and eat junk food, you are less able to deal with stress according to the Physicians Committee for Responsible Medicine.
- Use relaxation techniques. Your nerves might be shot. You might be on edge. Take time each day to sit quietly. Many apps offer self-guided meditation.
- Find a diversion. Use the time to binge watch a new television show or have a movie marathon with your family. Engage in a hobby you enjoy, read a book, take long walks.
- Lean on your family and friends. Seek out support to help you through the next couple of weeks. It is okay to lean on other people for emotional support. There might be times you want to talk or times you want to be alone, but knowing others love and support you makes it a little easier.
- Exercise. If you regularly exercise, keep up your routine if your doctor has said it is okay. If you don’t normally exercise, try taking a walk outdoors each day. Exercise calms the mind and reduces anxiety.
- Pamper yourself. This is a difficult few weeks. Do something nice for yourself. Treat yourself to a nice dinner, go for a spa treatment, splurge (within your budget) on something nice.
What you should not do:* ** Panic.*** ** Look online for information about your symptoms.** This tends to make you assume the worst and can increase your anxiety.
- Feel guilty about how you feel. You might feel like screaming (hopefully not at someone) or crying. You might be irritable. Let your family know that you are feeling stressed and ask for their understanding. Your mood might shift up and down very quickly. Don’t be too hard on yourself.
When your doctor’s office calls to say the results are in, don’t panic if they want you to come to the office to discuss them. Many doctors prefer to talk about biopsy results in person, no matter what the result. Don’t automatically assume the worst. Take a deep breath and know that you have the strength to deal with whatever may come.