Excisional biopsy

An excisional biopsy is when your doctor removes the affected area of skin and a small amount of the surrounding healthy tissue. You might have an excisional biopsy to both diagnose and treat skin cancer at the same time.

We usually use an injection of medicine to numb the area (local anaesthetic).

Once the area is numb your doctor removes the whole cancer by cutting it away. They also remove an area of healthy tissue from around it. This is the healthy margin. They remove the healthy margin to make sure that they have taken away all the cancer.  For larger lesions your doctor may remove a small sample of the lesion first (incisional or punch biopsy).

We usually use stitches to close the skin up.

The removed tissue sample is sent to the laboratory. A specialist doctor (pathologist) looks at the tissue under a microscope. They tell your doctor what type of cancer it is and give them other detailed information about it. They also look at the healthy tissue surrounding the cancer to make sure the margins are large enough.  The whole process might take up to 6 weeks, as some samples get sent to the UK for a second opinion.

Your results might need to be discussed by the Multidisciplinary Skin Cancer Team before the treatment plan is confirmed by your doctor. You might need further surgery to make sure they have removed all the cancer with a large enough healthy margin.

You’ll need the stitches removing usually after one to two weeks if you have non-absorbable sutures.

Wide local excision  (surgery to remove more tissue)

Wide local excision is surgery to remove a larger area of healthy skin and tissue. You have this surgery if the skin cancer diagnosis gets confirmed and there still might be skin cancer cells in the tissue near to the skin cancer. Removing this wider area of tissue helps reduce the risk of the cancer coming back. The amount of tissue the doctor removes depends on the size and type of the cancer, the localisation, and how much tissue was removed during the excision biopsy Your doctor will follow evidence-based guidelines (NICE, BAD) in determining how much more tissue needs to be taken.

Wide local excision is usually performed under local anaesthesia.

We usually use stitches to close the wound. This might feel a little tight at first. As it heals, the surrounding skin will stretch and the tightness should ease. It is important to avoid stretching of the skin for the first weeks after the surgery.

Sometimes the doctor removes a large area of skin. To repair this you might need a skin graft or skin flap.

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