What is a Mole Biopsy and what do the results mean?

By Ash 18th August 2021 Category: Advice

What is a mole biopsy and what do the results mean?

What is a biopsy?

A biopsy is an important diagnostic procedure where a sample of tissue is taken from an area requiring further investigation. This sample can then be analysed by a pathologist to provide a diagnosis.

There are different biopsy techniques that can be used depending on individual requirements. Important factors that will be considered by the specialist performing the biopsy include the location of the mole, the depth of sampling required, and how much tissue is needed to achieve an accurate diagnosis. In addition, the biopsy will be performed in a way that causes as little aesthetic or functional impact as possible.

Biopsies can be broadly categorised as either incisional or excisional:

  • Incisional biopsies involve taking a sample of the mole for testing. A punch biopsy is an example of this
  • Excisional biopsies involve removal of the whole mole using a scalpel both for treatment and diagnosis.

There are a number of different surgical techniques that are used. Your Consultant explains the different techniques and discusses the relative benefits of each type to ensure that the patient is able to give informed consent for their treatment. Some of the most widely used techniques include:

    • Punch biopsy – where the skin is numbed using anaesthetic and a biopsy of the area is taken using a specially designed piece of equipment called a punch.

    • Shave biopsy – where again the skin is numbed and the portion of the mole that is above the level of the skin is removed using a specialist blade.

mole removal

    • Curettage – where the mole is removed in a scraping motion using a sharp tool called a curette.

mole removal

    • Formal excision – where the mole is removed using a scalpel and the excision site is closed using sutures.

mole removal

Biopsies that involve removing the entire mole (excisional) can be the most appropriate option if the Consultant has any concerns regarding pre-malignancy or malignancy as it attempts to remove any chance of variation in the sample and reduces the chance of missing any important areas in the biopsy. A small border of normal tissue surrounding the mole will also be removed, you may hear this referred to as a margin. The aim is to remove everything in one procedure but sometimes based upon pathologist advice a second operation called a “wider-excision” might be required to ensure clearance to normal tissue.

Why might a biopsy be performed?

A skin biopsy is most often used to gather more information about the nature of the suspicious mole that can then be used to make or confirm a diagnosis.

Read more on what cancerous moles can look like and how to recognise them here

What happens during the procedure?

Any procedure can be associated with anxiety and worry about what will happen, whether it will be painful, and what the recovery process will involve. Here we provide guidance to help reduce some of the uncertainty around the mole biopsy procedure.

  1. Site selection – The area that the biopsy will be taken from will be decided and in some cases marked using a surgical marking pen.
  2. Skin preparation – The skin will be disinfected to remove any bacteria and residual oil.
  3. Anaesthesia – Local anaesthetic will be injected to numb the area so that the procedure will be as painless as possible. Adrenaline may also be added to reduce any bleeding during the biopsy and prolong the feeling of numbness. This is an important step that is taken to ensure that the patient is comfortable.
  4. Biopsy – The dermatologist will then perform the biopsy using specialist equipment. The details of this step will be explained by the dermatologist prior to the procedure as they vary on an individual basis.
  5. Site closure – Depending on the type of biopsy that is performed, the biopsy site may be closed with stitches or allowed to heal without stitches. An antiseptic ointment and non-stick dressing may then be applied.

The biopsy will then be prepared for histopathological testing at a specialist laboratory with the report provided by a Consultant Histopathologist expert in skin cancer.

What does the recovery process involve?

In order to reduce the risk of any complications and improve the cosmetic appearance following a biopsy, good aftercare is essential. Detailed aftercare instructions will be provided by the Consultant performing the biopsy as this will depend on the type of biopsy that has been performed.

You may be asked to keep the dressing covering the area dry for up to 48 hours. After this, it is important to remove the dressing and clean the area with warm soapy water. The area should then be dried gently, and a thin layer of ointment applied directly over the area. A waterproof plaster can then be applied to protect the area. This process should be repeated daily according to the advice provided by your Consultant.

If stitches have been used to close the biopsy site, these will be removed between 5 and 14 days after the procedure depending on the area.

There may be some pain and bruising around the biopsy site following the procedure. Over-the-counter pain relief can be taken according to the instructions to manage any pain. Bruising and/or swelling can be present for up to 2 weeks and a cold compress can be used to reduce this.

Will my mole grow back after a biopsy?

The chance of recurrence depends on the type of mole that was removed during biopsy. According to a study published in the Journal of the American Academy of Dermatology, across all mole types included, less than 5% were found to grow back after biopsy.

I have my results, what do they mean?

In this section we will provide general information focused on what to expect once you receive your biopsy results as we know that it is common to experience anxiety when waiting for mole biopsy results.

Your results will be communicated to you by your Consultant and you will also receive a copy of the histopathology report. This report consists of an expert’s analysis of your mole and will include a diagnosis of the sample provided to them.

The contents of your results will depend on the type of mole that has been sent for analysis, the suspected diagnosis, and whether or not the referring clinician would like to rule out any specific diagnoses.

If you have had a biopsy of an atypical mole that is being examined to rule out melanoma, any unusual features associated with your mole lead to an overall grading as either mildly, moderately or severely atypical. This does not mean that you have melanoma, and often, mild-moderately atypical moles that have been entirely removed require no further treatment. If any additional treatment, investigation or referral is required this will be discussed by your Consultant. Your Consultant will be part of an MDT (Multi-Disciplinary Team) who will review all cases of severely atypical to malignant pathology to ensure that appropriate follow-up is recommended and support provided to the patient.

Below we have collated a helpful glossary of terms that might be mentioned in your histology report to help make sense of any uncertainty. This should be used as a guide and any questions you have will be best answered by your Consultant.

Glossary

Acanthosis: thickening of the epidermis
Benign melanocytic nevus: a common harmless skin lesion (mole) due to proliferation of pigmented cells
Dysplasia: atypical or abnormal appearance of a cell or tissue
Malignancy: the presence of potentially invasive cancerous cells
Melanocyte: a skin cell that produces melanin to protect eh skin from ultraviolet radiation
Pre-malignant: a stage before becoming cancerous or malignant

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