Nikki Sommer, a nurse with Key West Surgical Group, joined Good Morning Keys on KeysTalk 96.9/102.5 FM for Medical Matters this morning.
It can be important to have certain skin lesions biopsied.
Sommer said, “There’s different types of skin lesion biopsies and for different reasons. So you came in and you were concerned about an area, and it didn’t need to be biopsied. But besides just when we talk about skin cancer, sometimes you can have a skin infection and it’s not going away, like a fungal, a bacterial or a viral infection, so they might take a little biopsy of it, just to see what it is, to make sure that it’s being treated correctly or if it needs to be treated a different way. Dermatitis, eczema, psoriasis, and then, of course, like we talked about, the skin cancers, the basal, the squamous and the melanoma.”
A shaved biopsy is one option.
Sommer said, “Way back when I started getting biopsied for skin cancer when I moved down here 20 years ago, I would have the dermatologist I went to would do a lot of shave biopsies, and basically it’s the least invasive method. It literally is taking, like a razor or a scalpel, and it shaves the top layer of the skin, and they will take that skin biopsy and send it off for pathology, and then, depending on what it comes back, as if it’s nothing, they leave it alone. If it’s something, then it may need to be cut a little deeper.”
If doctors need to go a little deeper, then it is a punch biopsy.
Sommer said, “literally looks like a punch. If the lesion is round, there’s certain sizes, I think they’re three millimeter, four millimeter, and there might be some additional, they literally will kind of like twist and punch the lesion and then pull it and cut it out. That’s if you feel like the lesion is going deeper into the skin, they may opt for a punch biopsy, and again, it’s then sent off to pathology and analyzed to see whether it’s something that needs to be surgically removed, further, or it’s just a benign finding, and you can leave it alone.”
Then there’s an incisional biopsy.
Sommer said, “During an incisional biopsy, like they will cut the suspicious portion and a lot of times they will try and get some margins a little bit bigger around the lesion, just to make sure, especially if it looks suspicious. A lot of times, if it’s malignant, it will come back as either the borders are clear are not clear, and depending on that, then you might need a deeper biopsy, known as the excisional biopsy, which then removes the entire lesion all together, including all three layers of the skin. And that’s usually when there’s malignancy detected, such as basal cell, squamous cell and melanoma.”
If a patient is on blood thinners, they will need to let the doctor know.
Sommer said, “If you are on a blood thinner, you take aspirin, you need to let us know, because you’re just at risk for bleeding. Sometimes, if you can’t stop your blood thinner for whatever reason, Dr. Smith will tend to use what’s called an option to kind of stop that bleeding during the biopsy. You are numbed with, usually, lidocaine, and that is always, usually the most painful part, because you feel a stick and a burn. I really feel like when I’ve had my biopsies, getting the lidocaine is the worst. It’s a stick and a burn, and then I don’t feel anything else.”
How long will it take to get results?
Sommer said, “Now we do a lot of biopsies in the office, sometimes in the case, when it’s like squamous cell or melanoma, if it’s going to be a deeper specimen or if somebody comes in with a significant, large lesion, sometimes we’ll biopsy it here and then, while, again, most of it can be done here, sometimes you do need to go have it done outpatient, depending on the size of the specimen or the area that needs to be removed. Melanoma, if it goes deep into the tissue, that usually becomes a more invasive surgery. It could take anywhere from a several days to two weeks for the pathologist to review everything and send us back what the diagnosis is and then the doctors, will decide what the treatment and the next steps for the treatment will be after that.”
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