CancerQuest | Types of Biopsies

There are several different types of biopsy. The type used depends on the goal of the biopsy (i.e. remove the entire lesion or obtain a small sample), the cancer type and the location of the cancer.

1. Incisional

An incisional biopsy removes only a portion of a suspected tumor.⁽¹⁾ This technique is used when a lesion is too large to remove entirely or when the location of the tumor would result in unacceptable amounts of scarring. Incisional biopsies may require local anesthesia and may or may not require stitches.

2. Excisional

An excisional biopsy removes the entire tumor and some surrounding tissue.⁽¹⁾ If a diagnosis of cancer results, the biopsy will have removed the entire tumor. An excisional biopsy is done using local anesthesia and is the most invasive of all the biopsy techniques. The wound may need to be stitched closed or a skin graft may be needed. These biopsies usually produce a scar.

There are various different techniques used for excisional and incisional biopsies. Punch, Shave, and Needle.

Punch

A punch biopsy is used to collect a deep sample of skin and is usually used for large lesions or lesions on the palm, sole, finger/toe, face, and ear. This technique removes a portion of skin approximately ¼ inch deep, consisting of the epidermis, dermis, and upper subcutaneous tissue. A circular blade is used to perforate the skin and the specimen is lifted with a needle and cut with a pair of scissors. The resulting wound is sutured closed and may result in a scar.
Shave

A shave biopsy removes the epidermis and a small portion of the dermis. This technique uses a surgical blade or razor to shave off a portion of the skin. This procedure is easy on a patient because it is relatively pain free (done under local anesthesia) and requires no stitches. Shave biopsies are not normally used for suspected melanoma because the cut is not deep enough to allow measurement of the depth to which the lesion has spread.
Needle

A needle biopsy is rarely used to obtain skin tissue; it is usually used to remove a sample from internal organs, lymph nodes, or deep skin areas. These techniques involve the use of a small, hollow needle and is sometimes aided by an imaging technique such as x-ray. There are two types of needle biopsy, fine needle aspiration (FNA) and core needle biopsy. They differ in the amount of tissue removed. Core needle biopsies remove a larger tissue sample than FNA.⁽¹⁾