Recognition of skin cancer patterns

Choice of biopsy technique

Choice of biopsy technique depends on the type of skin lesion. Most basal cell and squamous cell carcinomas can be adequately biopsied by the shave technique because the pathology is superficial and the prognosis is not determined by thickness. Exceptions include sclerosing basal cell carcinomas and very flat superficial basal cell carcinomas, which are best biopsied with a full-thickness specimen in the form of a punch biopsy or excisional biopsy.

All lesions you suspect may be melanoma should be biopsied with a full-thickness specimen. Very small and very large lesions can initially be biopsied using a punch instrument. The excisional biopsy is preferred when the lesion can be removed with one surgical procedure. Depending upon the depth of the melanoma, you may need to perform a second surgery to get adequate margins.