Diagnosis
If you have any signs or symptoms of skin cancer, see your doctor as soon as possible. Your doctor will thoroughly examine your skin and ask you about your general health, lifestyle, and family history. You may need to see a dermatologist (skin doctor), who may use a dermatoscope, a magnifying lens with a light, to look at the skin more closely. If your doctor suspects a spot may be skin cancer, a biopsy may be performed to establish a diagnosis. A biopsy is the best way to determine the diagnosis. Here are some procedures your doctor may recommend to diagnose skin cancer:
Skin Biopsy
A biopsy is the best way to be certain that a spot on your skin is cancer. Your doctor will take a tissue sample from a suspicious area of your skin and have it sent to a lab to be examined under a microscope. There are a few different types of skin biopsies your doctor may recommend.
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Shave Biopsy
Your surgeon uses a razor blade to shave off the outer layers of the skin to be examined under a microscope. A shave biopsy is best for thin lesions.
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Punch Biopsy
Your surgeon uses a special instrument to remove a cylinder of tissue from deeper layers of skin. A punch biopsy is good for determining the depth of the lesion.
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Incisional Biopsy
Your surgeon uses a scalpel to make an incision and remove only a part of the suspected tumor for examination.
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Excisional Biopsy
Your surgeon uses a scalpel to remove the entire lump or spot and a margin of surrounding tissue for examination.
Lymph Node Evaluation
Most BCCs and SCCs are identified in early stages and the risk of spread to regional lymph nodes is very small. If your doctor performs a lymph node evaluation and identifies an enlarged lymph node, special lymph node testing may be performed (fine needle aspiration or lymph node biopsy). Additionally, if a patient has an aggressive BCC or SCC, special lymph node testing may be performed at the time of the removal of the skin cancer to test the regional nodes (sentinel lymph node biopsy). Below are common lymph node tests:
Lymph Node Biopsy: Your doctor may arrange for a patient to have a biopsy of a lymph node biopsy to find out whether cancer has spread to the lymph nodes. This procedure is a sample of the enlarged lymph node.
Excisional Biopsy: If the needle biopsy is unsuccessful in providing a diagnostic sample or the entire lymph node requires evaluation, your doctor may arrange for an excision of an entire lymph node to be examined under a microscope.
Sentinel Node Biopsy: In about 5% of SCCs, the risk of spread beyond the skin may prompt your doctor to evaluate regional lymph nodes. In the setting of high-risk SCCs, your doctor may recommend a sentinel lymph node biopsy. These biopsies are coordinated with your skin cancer removal and are performed in an operating room. With this procedure, a blue dye with radiotracer is injected in the skin surrounding the cancer. The radioactive dye travels to the regional lymph nodes that are not enlarged on physical examination. A device that identifies radioactivity is then used to identify the closest lymph nodes (sentinel nodes) that drain the tumor. The surgeon removes the blue, radioactive, 1-3 lymph nodes for evaluation by a pathologist. If the sentinel node is negative, usually no further treatment to the lymph nodes is required. If the sentinel node is found to contain tumor cells, your doctor may recommend further treatment to or closer follow-up of the remaining lymph nodes.
