ENGLISH 
Mole Biopsy
Melanoma, the most serious type of skin cancer, develops in the cells (melanocytes) that produce melanin. It can be identified by a biopsy of a mole on your skin.
Skin cancer screening and mole removal (excision biopsy) for histological analysis is recommended when you have either new moles, changing moles or a history of multiple moles which is known as atypical mole syndrome. Moles can also be removed for cosmetic reasons, for instance if very visible on your face or on your trunk where they catch on clothing. Before the biopsy you will require an assessment with dermatoscopy and photography by the Consultant Dermatologist and their nurse, who will then indicate the likelihood of your mole being a melanoma.
A biopsy is a medical procedure of taking a small solid sample of body tissue to be examined under a microscope, the histopathological analysis.
Different biopsy techniques can be used depending on individual requirements. The biopsy specialist will consider essential factors, including the mole’s location, the depth of sampling needed, and how much tissue is required to achieve an accurate diagnosis. Furthermore, the biopsy will be performed in a way that causes as little aesthetic or functional impact as possible.
Skin biopsies are categorised as either incisional or excisional:
- Incisional biopsies require taking a sample of the lesion for testing.
If a malignant melanoma is suspected, an incisional biopsy is contraindicated. If another type of skin cancer such as basal cell carcinoma or squamous cell carcinoma is suspected, an incisional biopsy is ideal for confirming the diagnosis prior to deciding definitive treatment. - Excisional biopsies require the removal of the whole mole for diagnosis and treatment.
When a malignant melanoma is suspected, prompt full-thickness excision biopsy is required.
Biopsy Techniques
The specialist dermatology consultant at Clinica London will explain the surgical technique and aftercare, together with follow up, to ensure that the patient can give informed consent for their treatment.
Different Biopsy Techniques:
Punch biopsy is where the skin is numbed using an anaesthetic, and a biopsy of the area is taken using a unique piece of equipment called a punch. This is suitable for small lesions only.
Shave biopsy is where again, the skin is numbed, and the portion of the mole above the skin level is removed using a specialist blade. This is suitable for obviously benign moles being removed for cosmetic reasons.
Curettage is where the mole is removed in a scraping motion using a sharp tool called a curette. This is suitable for obviously benign moles being removed for cosmetic reasons.
Formal excision is where the mole is removed using a scalpel, and the excision site is closed using sutures or allowed to heal by secondary intention. Sufficient depth and clear surrounding tissue is required when a malignant melanoma is suspected from the history and dermatoscopic appearance.
What happens during the procedure?
Any procedure is usually associated with anxiety and worry about what will happen, whether it will cause discomfort, and what the recovery process will involve. To help calm those pre-op nerves, here is a step-by-step walkthrough of the procedure:
Site selection – The area of the skin that the biopsy will be taken from will be decided and marked using a surgical marker.
Preparing the skin – The skin will be disinfected to kill any unwanted bacteria and remove residual oil.
Anaesthesia – To numb the area so that the procedure will be as painless as possible local anaesthetic will be injected. This is crucial to ensure that the patient is comfortable. Adrenaline may also be added to reduce bleeding during the biopsy and prolong the feeling of numbness.
Biopsy – The dermatologist will then undergo the biopsy using specialist equipment. The dermatologist will explain the details of this step before the procedure as they vary individually.
Site closure – Depending on the biopsy performed, the biopsy site may be allowed to heal with or without stitches. An antiseptic ointment should be applied, which will be followed by a non-stick dressing may then be used.
The biopsy will then be ready for histopathological testing with the report provided by a Consultant Histopathologist expert in skin cancer a few days later. If special stains are required the time from biopsy to Histopathology Report may be over a week.
What does the recovery process involve?
Good aftercare is essential to reduce the risk of complications and improve the cosmetic appearance following a biopsy. Aftercare instructions will be provided by the specialist performing the biopsy, depending on the type of biopsy performed.
You should be asked to keep the dressing covering the area dry for 48 hours. After this, remove the bandage and clean the area with warm soapy water. The site should then be dried gently, and a thin layer of ointment should be applied directly over the affected area. A waterproof plaster can then be used to protect the area. This procedure should be repeated according to the advice provided by your consultant.
Depending on the area, if stitches have been used to close the biopsy site, they will be removed between 6 and 14 days after the procedure.
There may be tenderness and bruising around the biopsy site following the procedure. Over-the-counter pain relief can be taken to manage pain. Bruising and swelling may last for two weeks, and a cold compress can be used to reduce this.
The results of the biopsy will be discussed with the patient at the follow up consultation. Very occasionally further medical or surgical diagnostic procedures or treatments are indicated if there is an advanced stage malignant melanoma.
Skin cancer screening and Mole Removal
At Clinica London our Dermatologist will screen your skin for moles, by doing a mole check. They will examine and remove individual moles to make the Mole Diagnosis and exclude malignant melanoma. They will also remove Moles for cosmetic reasons. It is recommended that if you are prone to Moles that you have an annual check by the Dermatologist and their Nurse.
Dr Jennifer Crawley is the Clinica London Dermatologist. The nurse assistant and chaperone is present at all the stages of the mole assessment and diagnosis. All biopsies are done on site in Clinica London´s operating theatre which is Care Quality Commission registered for surgical procedures on skin.