Types of Skin Biopsy

How, when, and why they are done

If you have a suspicious spot on your skin, your healthcare provider may recommend a biopsy to check for skin cancer. A biopsy is the removal of a tissue sample from the concerning site so that it can be studied under a microscope to confirm whether or not any cancer is present.

There are several types of skin biopsy procedures that may be done, and different biopsy types may be recommended for different kinds of skin lesions.

This article will help you to understand the types of skin biopsy, how the procedures work, and what you might expect next once you and your healthcare provider receive the skin biopsy results.

Doctor examining a woman for melanoma
Getty Images / Peter Dazeley / Photographer's Choice

Types of Skin Cancer Biopsies Can Confirm

There are three primary types of skin cancer. The type of skin cancer that is suspected will determine which type of skin biopsy technique is used.

  • Squamous cell skin cancer: Squamous cell carcinoma of the skin sometimes begins as an actinic keratosis, a scaly lesion with a red base that's related to sun exposure. This is the second most common type of skin cancer.
  • Basal cell carcinoma of the skin: Basal cell carcinoma is the most common form of skin cancer, responsible for around 80% of these tumors. A basal cell carcinoma's appearance is often pearly. The tumor usually begins as a skin bump that eventually becomes depressed in the center, like a volcano.
  • MelanomaMelanoma is the most serious form of skin cancer. It is responsible for the majority of deaths from the disease. The staging of melanoma, which affects the treatment plan and your prognosis, depends on accurately establishing the depth of the tumor. This affects the type of skin cancer biopsy your healthcare provider may choose.

Squamous cell and basal cell carcinomas are considered non-melanoma skin cancers and rarely spread to distant parts of the body. Most skin biopsy procedures can be used to diagnose these cancers, but the same is not true with melanoma.

It's important to remember that having a skin cancer biopsy means that your healthcare provider is concerned about the possibility of cancer. It does not mean that you have cancer.

Skin Biopsy Techniques

The skin cancer biopsy that a healthcare provider recommends is based on the type of lesion(s) that they need to investigate. Here's a review of the main types of skin biopsy.

Shave Biopsy

A shave biopsy is a fairly simple skin cancer biopsy and the most common of them. It works best with lesions that are raised. It is very similar to how you would shave your face or your legs, though deeper so that it removes the epidermal layer of the skin and the top part of the dermis.

It is often the preferred method of evaluating skin lesions on the foot since it does not carry the risk of separating and bleeding after the procedure.

After the biopsy is taken, the area where the skin was removed can be cauterized to prevent bleeding with aluminum hydroxide solution or silver nitrate (although this can stain the skin). The area should be kept clean and moist for a week to minimize scarring.

Punch Biopsy

A punch biopsy is performed in a method similar to a paper punch or a cookie cutter, and it removes a section of tissue shaped like a cylinder.

Punch biopsy tools come in different sizes. Your healthcare provider will choose the size that is able to remove the best sample with the least amount of scarring.

The sample is obtained from the selected site by rotating the tool. A punch biopsy can be used to take a sample of a suspicious lesion, or sometimes to remove the entire lesion if it is small. It takes a deeper sample than a shave biopsy, by removing the epidermis, the dermis, and a small amount of the subcutaneous tissue (or subcutis). The area is often closed with a suture.

Incisional or Excisional Biopsy

Incisional and excisional biopsies are both performed with a surgical knife. The difference is that an excisional biopsy, recommended for a suspected melanoma, is done to remove the whole lesion.

An incisional biopsy removes just a portion of the tissue for evaluation. An elliptical incision is often made in order to help with closing the incision after the tissue is removed.

Studies have not found that the type of skin cancer biopsy you get makes as significant a difference in survival as was once thought. Still, having the right skin cancer biopsy does increase the accuracy of the diagnosis and cancer staging, which influences your treatment options and prognosis.

Is a Skin Biopsy Dangerous?

Skin biopsy is generally considered a safe procedure. While complications are uncommon, they can occur.

Bleeding and infection are two possibilities. If you have a bleeding disorder or take any medications that increase bleeding, talk to your healthcare provider. Keep in mind that some herbal supplements may increase bleeding as well.

Some people wonder if the biopsy itself could cause the spread of any cancer present. The research suggests an extremely low risk of this happening, although it is theoretically possible. The greater risk, in this sense, would be not having a skin cancer biopsy to detect and then treat your cancer.

Healing After a Skin Biopsy

A skin biopsy site usually takes about two to three weeks to heal, but it can take longer if you do not follow your healthcare provider's instructions for caring for your wound.

No matter which type of skin cancer biopsy you have done, it is important to keep your incision or biopsy site clean. You also may avoid any activity that stresses the biopsied area.

There is no way to prevent scarring when a biopsy is done, but you may be able to minimize it by keeping the area clean to avoid infections that raise the risk of scarring.

Skin Biopsy Results

How long it takes for skin biopsy results to come in can vary, but pathology labs typically return results to healthcare practitioners in several days. These results will tell you if the skin area is cancerous or not.

Ask your healthcare provider when they expect to get the report and if they will be calling you with skin biopsy results, or if you need to schedule a follow-up appointment.

If your skin biopsy reveals a melanoma, further biopsies may be done to evaluate the lymph nodes in the area near the tumor. This may involve what's called a lymph node dissection.

A Word From Verywell

If you are having a skin cancer biopsy, know that when skin cancer is caught early, it is highly treatable. You may also want to learn more about skin cancer prevention, regardless of the outcome of your skin cancer biopsy.

Also remember that it's important to be an informed advocate when it comes to your medical care. Ask questions about your skin cancer biopsy, carefully select your providers, and don't hesitate to get a second opinion.

Frequently Asked Questions

  • Does a biospy hurt?

    It shouldn't. Your healthcare provider will numb the skin ahead of time, usually by injecting lidocaine at the biopsy site. If you are very sensitive to pain, lidocaine may be applied to the skin first. There should be minimal pain following the biopsy.

  • What percentage of skin biopsy results indicate cancer?

    One study found that skin cancer was detected by biopsy in 44.5% of cases. Most of these cases were highly treatable basal cell carcinomas.

11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. The Skin Cancer Foundation. Actinic Keratosis.

  2. Marzuka AG, Book SE. Basal cell carcinoma: pathogenesis, epidemiology, clinical features, diagnosis, histopathology, and management. Yale J Biol Med. 2015;88(2):167-79.

  3. American Cancer Society. Tests for Melanoma Skin Cancer.

  4. Consultant360. Skin Biopsy Techniques: When and How to Perform Shave and Excisions Biopsy.

  5. Yamashita Y, Hashimoto I, Abe Y, et al. Effect of biopsy technique on the survival rate of malignant melanoma patients. Arch Plast Surg. 2014;41(2):122-5. doi:10.5999/aps.2014.41.2.122.

  6. Stanford Medicine. Medications and Herbs That Affect Bleeding.

  7. American Society of Clinical Oncologists. Can a Biopsy Make My Cancer Spread?

  8. Yale Medicine. Skin Biopsies: What You Should Expect.

  9. The Skin Cancer Foundation. Skin Cancer Prevention: Protect Yourself With A Complete Approach.

  10. Kilic A, Kilic A, Kivanc AE, Sisik A. Biopsy Techniques for Skin Disease and Skin Cancer: A New Approach. J Cutan Aesthet Surg. 2020 Jul-Sep;13(3):251-254. doi:10.4103/JCAS.JCAS_173_19

  11. Weinstein DA, Konda S, Coldiron BM. Use of Skin Biopsies Among Dermatologists. Dermatol Surg. 2017 Nov;43(11):1348-1357. doi:10.1097/DSS.0000000000001188

Additional Reading
  • Farber, A., and D. Rigel. A Comparison of Current Practice Patterns of US Dermatologists Versus Published Guidelines for the Biopsy, Initial Management, and Follow-Up of Patients with Primary Cutaneous Melanoma. Journal of the American Academy of Dermatology. 2016;75(6):1193-1197.

  • Madu, F., Wouters, M., and A. van Akkooi. Sentinel Node Biopsy in Melanoma: Current Controversies Addressed. European Journal of Surgical Oncology.

  • U.S. National Library of Medicine. Skin Lesion Biopsy.

  • Kasper, Dennis, Anthony Fauci, Stephen Hauser, Dan Longo, and J. Jameson. Harrison's Principles of Internal Medicine. New York: McGraw-Hill Education, 2015. Print.

By Timothy DiChiara, PhD
Timothy J. DiChiara, PhD, is a former research scientist and published writer specializing in oncology.