Biopsies, Diagnoses, and Treatment Options for Skin Cancer

Skin cancer is highly treatable when caught soon enough, so early detection is key. A dermatology provider should examine any suspicious lesions found during a self-examination of your skin (or a FBSE appointment). Typically, a biopsy of the lesion is taken to confirm a diagnosis. This provides meaningful information about the type of cancer found and what treatment options are available. 

The Importance of Biopsies

Dermatology providers have the training and experience to help decipher between a benign lesion and a potentially harmful skin cancer. However, they will always order a skin biopsy of any suspicious lesion to help aid in reaching a definitive diagnosis. A biopsy is an easy, in-office procedure where a small piece of the tissue is removed from the lesion and sent to a dermatopathologist, where it is reviewed and diagnosed appropriately. This is done by numbing the skin with a local injectable anesthetic and using a blade or a skin punch instrument to remove a small piece of tissue. It is no worse than a bee sting and only occasionally are stitches needed to close the wound. Healing time for the wound is typically 10-14 days, depending on the location of the biopsy. (Read more about Wound Care.)

Confirming a Diagnosis

Once collected, biopsy tissue gets sent to a laboratory where a dermatopathologist reviews the sample at a microscopic level. They can then confirm a diagnosis, allowing the provider to develop an appropriate treatment course. In most cases, a biopsy only removes a small sample of the lesion to confirm a diagnosis. It is NOT a full removal of the skin cancer. Additional treatment will likely be warranted to ensure complete removal of cancerous tissue. Biopsy results are typically returned within 7-10 days. A Goodskin associate will contact the patient to discuss their results and advise if further treatment is necessary.

Common Skin Cancer Treatment Options

After biopsy results have been returned, your provider will use them to create an effective and appropriate treatment plan based on the type and severity of skin cancer present. Often, treatment options are fairly straightforward and minimally invasive. In certain cases, surgical options are required to achieve complete removal of cancerous tissue. 

Curettage and Desiccation

Also known as C&D (or ED&C), this treatment is a scraping and burning technique commonly used to remove layers of cancerous tissue.

After a local anesthetic is injected, the lesion is scraped with a sharp-edged tool called a curette to remove malignant tissue. Then, an electro-desiccation device is used to cauterize the wound, which prevents excess bleeding and destroys remaining cancerous cells. This removal heals in 4-6 weeks by secondary intention, which means no stitches are used.

 

Topical Chemotherapy Cream

Another common method used to treat skin cancer is chemotherapy cream. This is a prescription medicinal cream that can be applied directly to a cancerous lesion to treat it. 

This cream is used on superficial skin cancers only, and can be a very effective, non-invasive treatment option. This treatment option is a 6-week course that causes inflammation and irritation to the site in which it is being applied. This is a necessary response to achieve successful results.


Excision

This is when the skin cancer is removed from the body by cutting around the lesion using a scalpel. Stitches will be required to close the wound and remain in for 7-14 days, dependent upon the location of the excision on the body.

Any tissue removed by excision is then sent to a dermatopathologist to confirm that clear margins were achieved and no lingering cancer cells remain. 

Mohs Surgery

In some cases, skin cancers appear on parts of the body where a more delicate approach to treating them is necessary. Mohs micrographic surgery is a highly specialized, advanced surgical technique that is often utilized to treat these more technical cases. This type of surgery is tissue-sparing, meaning that the surgeon will remove the cancerous lesion while keeping as much of the unaffected surrounding tissue intact. By using this approach, the surgeon can ensure the complete removal of the cancerous tissue and still suture the wound in such a way as to minimize scarring. Mohs surgical procedures do require patients to wait while the surgeon ensures they have achieved clear margins before the wound is stitched closed. However, the benefit of this procedure is that a patient will know that a skin cancer has been fully removed by the end of the appointment. 

What to Expect From Mohs

Calendar

Preparing for Surgery

Ahead of your appointment, you will prepare for surgery according to the provider's instructions. This includes discussing medical history and suspending certain medications.
Scalpel

The Procedure

After a local anesthetic is administered, your surgeon will remove the cancerous lesion and a small layer of tissue surrounding the area. Your wound is then bandaged and you will wait as the surgeon reviews the tissue.
Microscope

Checking for Margins

The surgeon prepares tissue samples to review under a microscope to ensure all cancer has been removed. Results are usually returned within 30-45 minutes.
Stopwatch

Ensuring Full Removal

If there is still evidence of cancerous cells, the surgeon will remove another layer of tissue and repeat the review (sometimes multiple times) until they see clear margins of healthy skin all around the wound.
Needle

Finishing Up

When the surgery site has been determined to be cancer free, your surgeon will close the wound, typically with stitches, in a way that will minimize scarring. Wound care instructions should be carefully followed to ensure complete healing.

Learn more about the specifics of Mohs surgery here.

The Importance of Follow-Up Appointments

Once you’ve been diagnosed with skin cancer, you are considered at greater risk of developing another skin cancer over your lifetime. This is why it is so important to schedule and attend follow-up appointments. These appointments will allow your provider to check for recurrence of past-treated cancer. They will also be opportunities for your provider to catch any new cancerous growths and work on prevention. Your surgeon or dermatology provider will advise you of an appropriate follow-up schedule.