The Different Types of Skin Cancer Biopsies

If you have a suspicious spot on your skin, your healthcare provider may recommend a biopsy to check for skin cancer. This may bring to mind several questions. What types of skin cancer biopsy procedures may be done, and why are different procedures recommended for different lesions? Will it hurt? What information will your practitioner receive from the pathologist and what will be the next steps? Find out more details about the skin cancer biopsy process, below.

Doctor examining a woman for melanoma
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What Is a Skin Cancer Biopsy?

A skin cancer biopsy is done to see whether an abnormal spot on your skin could be cancer. Skin cancer is a very common condition, affecting over a million people each year in the United States.

Types of Skin Cancer

There are three primary types of skin cancer, and what type of skin cancer that you have will determine which type of skin cancer biopsy 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 percent of these tumors. The appearance of a basal cell carcinoma is often pearly and the tumor usually begins as a bump on the skin that eventually becomes depressed in the center (like a volcano).
  • MelanomaMelanoma is the most serious form of skin cancer and it's responsible for the majority of deaths from the disease. Since the staging of melanoma (which affects the treatment plan and your prognosis) depends on accurately establishing the depth of the tumor, the type of skin cancer biopsy that your healthcare provider chooses will be one that preserves the tumor as accurately as possible.

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.

Types of Biopsies

  • Shave biopsy: A shave biopsy is a fairly simple skin cancer biopsy that is very similar to how you would shave your face or your legs, though deeper. It is the most commonly performed type of biopsy, and it works best with lesions that are raised. This type of biopsy 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 cylindrical section of tissue. Different sized punch biopsy tools are available and your healthcare provider will choose the size that is able to remove the best sample with the least amount of scarring. The area to be biopsied is chosen and the sample is obtained by rotating the tool. A punch biopsy can be used to take a sample of a suspicious lesion (or sometimes remove the entire lesion if it is small). A punch biopsy takes a deeper sample than a shave biopsy, removing the epidermis, the dermis, and a small amount of the subcutaneous tissue (or subcutis). The area is often closed with a suture.
  • Incisional and excisional biopsies: Incisional and excisional biopsies are both performed with a surgical knife. The difference is that an excisional biopsy (recommended if melanoma is suspected) is done to remove the whole lesion, whereas an incisional biopsy removes just a portion to evaluate. An elliptical incision is often made in order to help with closing the incision after the tissue is removed.

Choosing the Right Biopsy

While recent studies have not found that the type of skin cancer biopsy makes a significant difference in survival as had been thought in the past, an appropriate biopsy increases the accuracy of the diagnosis and the cancer staging, which influences your treatment options and prognosis.

The crux of these findings is that you need to be an informed advocate when it comes to your medical care. Ask questions, carefully select your providers, and don't hesitate to get a second opinion.

Will a Biopsy Hurt?

Before a skin cancer biopsy is performed, your healthcare provider will numb the skin, usually by injecting lidocaine throughout the area to be biopsied. For those who are very sensitive to pain, the area can first be numbed with topical lidocaine that's applied for 20 or 30 minutes prior to the injection of lidocaine. Following the biopsy, you should have minimal pain.


No matter which type of skin cancer biopsy you have done, it is important to keep your incision or biopsy site clean. There is no way of preventing scarring when a biopsy is done, but you may be able to minimize scarring by keeping the area clean to avoid infections (which can increase scarring) and by avoiding stressing the area biopsied.


Complications are uncommon with a skin biopsy but may include bleeding and infection. If you have a bleeding disorder or are on any medications that increase bleeding, talk to your healthcare provider. Keep in mind that some herbal supplements may increase bleeding as well.


It usually takes several days before your practitioner receives a pathology report from the lab. This determines whether or not the skin area is cancerous. Ask your healthcare provider when he or she expects to get the report and find out whether he or she will be calling you with 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. Learn more about the pros and cons of lymph node dissection with melanoma.

The Bottom Line

If you are having a skin cancer biopsy for an abnormal lesion on your skin, you are probably feeling anxious. It doesn't help when people suggest that it may "only" be skin cancer. Any type of cancer is frightening and it's normal to feel nervous. The good news is that when skin cancer is caught and treated early, it's curable, so regularly seeing a dermatologist for check-ups is always a good idea. 

Whether or not your results reveal cancer, take a moment to learn about skin cancer prevention. Wearing a broad-spectrum sunscreen daily—especially when you have to be outdoors for a prolonged period of time—is important, along with staying indoors during the middle of the day, seeking out shade, and wearing sun-safe clothing such as rash guards, hats, and sunglasses.

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7 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. Reviewed May, 2019.

  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. Updated August 14, 2019.

  4. Consultant360. Skin biopsy techniques: When and how to perform shave and excisions biopsy. July 2012.

  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. The Skin Cancer Foundation. Skin cancer prevention: Protect yourself with a complete approach. 2019.

Additional Reading
  • U.S. National Library of Medicine. Skin Lesion Biopsy. Updated 12/02/14.

  • 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.
  • Kasper, Dennis, Anthony Fauci, Stephen Hauser, Dan Longo, and J. Jameson. Harrison's Principles of Internal Medicine. New York: McGraw-Hill Education, 2015. Print.
  • Madu, F., Wouters, M., and A. van Akkooi. Sentinel Node Biopsy in Melanoma: Current Controversies Addressed. European Journal of Surgical Oncology. 2016 Aug 24. (Epub ahead of print).