Skin biopsy and histopathological examination

A skin biopsy is a procedure in which the doctor removes a small sample of skin, or the whole lesion, so that it can be examined under a microscope. This analysis is called a histopathological examination and is carried out in a pathology laboratory by a specialist doctor.

A biopsy is one of the most important ways of establishing precisely the nature of a skin lesion, especially when clinical examination and dermoscopy are not enough for a reliable diagnosis. At Detalii Med in Baia Mare, biopsies are performed by Dr Alina Perța, Dr Greta Jurj, Dr Marius Pruna and Dr Valeria Pruna.

A skin biopsy may be recommended in situations such as:

• suspicious lesions that have changed in appearance or are not healing;
• moles that have changed in shape, colour, size or outline;
• rashes or patches whose cause is unclear;
• skin conditions where the diagnosis needs to be confirmed before treatment.

The decision to perform a biopsy rests with the doctor, following a dermatological assessment. Patients need not be alarmed: a recommendation for a biopsy does not mean the lesion is serious, only that a reliable confirmation is needed.

Histopathological examination can establish the nature of the lesion, show whether it is benign or has features that require further treatment, and guide the choice of appropriate treatment. When the whole lesion is removed, the report also shows whether the margins are clear.

A biopsy is not in itself a cosmetic treatment. In some cases, especially when only a sample has been taken, a further procedure may be needed to remove the lesion completely. Sometimes the result has to be correlated with other investigations, or a repeat biopsy is needed for clarification.

Before the biopsy, the doctor examines the lesion carefully, usually with dermoscopy as well, and asks how long it has been present, whether it has changed and whether it causes any symptoms. Medical history, family history of skin conditions, allergies and current medication are discussed, particularly medicines that affect blood clotting.

The doctor explains why the biopsy is recommended, which type of sampling is appropriate, how the area will look after the procedure and roughly how long the result will take. The patient has the opportunity to ask any questions before giving consent.

The procedure is usually short, lasting between 15 and 45 minutes depending on the size and location of the lesion. The area is cleaned, disinfected and numbed with local anaesthetic.

Depending on the case, the doctor takes a small sample of skin or removes the whole lesion. The wound may be closed with a few stitches or left to heal under a dressing. The sample is placed in a special container and sent to the pathology laboratory together with the necessary clinical information.

The biopsy is performed under local anaesthesia. The doctor injects an anaesthetic around the area, which may cause a brief stinging or burning sensation. After that the area becomes numb, and the patient usually feels only light pressure.

The patient can go home straight after the procedure and resume most activities the same day. The area may be slightly tender for a few days.

Usual recommendations:

• keep the dressing clean and dry, as instructed;
• avoid activity that stretches the area if stitches have been placed;
• follow the local wound care recommended by the doctor;
• attend the follow-up for stitch removal, usually after one to two weeks depending on the area.

A skin biopsy is a low-risk procedure, but the following may occur:

• minor bleeding or bruising;
• local infection, rarely;
• delayed healing, especially on the lower legs or in people with certain conditions;
• a scar, which usually fades over time;
• rarely, a thickened scar or changes in skin colour.

Spreading redness, increasing pain, local warmth or discharge should be reported to the doctor.

The result of the histopathological examination usually arrives within one to three weeks, depending on the laboratory and the complexity of the case. Additional tests are sometimes needed, which extend this interval.

The doctor discusses the result with the patient and explains what it means. If needed, the next step is agreed: monitoring, complete removal of the lesion or other treatment.

A skin biopsy with histopathological examination provides an accurate diagnosis when a skin lesion raises questions. For changing moles and suspicious lesions, dermatological assessment and, where needed, microscopic analysis are important steps. At Detalii Med, the doctor explains each stage and discusses the result with the patient.