Skin Biopsies & Diagnosing Dermatological Conditions


Medically Reviewed by Dr. Lee Hwee Chyen

MBBS MRCP (UK) FAMS (Dermatology)

Skin Biopsies & Diagnosing Dermatological Conditions

What Is a Skin Biopsy?

A skin biopsy involves the surgical removal of a small sample of skin tissue for microscopic examination. It allows a range of skin diseases, from benign lesions to malignant tumours, to be diagnosed.

Types of Skin Biopsies

Each type of biopsy is suited for different diagnostic purposes and has its specific applications.

Shave Biopsy

The upper layers of the skin are removed using a surgical blade to diagnose lesions that protrude above the skin surface, such as moles or skin tags. It is less invasive and ideal for diagnosing and removing superficial skin growths.

Punch Biopsy

A circular tool is used to remove a small, round piece of skin, including deeper layers below the skin. This helps diagnose inflammatory skin conditions and small lesions that require a deeper tissue sample.

Excisional Biopsy

This involves removing the entire lesion surgically so that it can be removed with a low risk of recurrence and also sent for histological evaluation.

Incisional Biopsy

A portion of a large lesion is removed for examination. Sufficient tissue is retrieved to diagnose a possibly malignant lesion that is too large to be completely removed at the initial assessment.

Dermatological Conditions Diagnosed Through Skin Biopsy

The histological examination of skin tissue samples via a biopsy allows for the identification of diseases that may not be discernible through visual inspection alone.

Benign Skin Lesions

Conditions such as moles, cysts, and benign growths can be confirmed through biopsy. Benign lesions can be distinguished from malignant ones.

Inflammatory Skin Diseases

Via microscopic examination, inflammatory skin conditions like psoriasis, eczema, and lupus can be diagnosed. This reveals specific patterns of inflammation and cellular changes characteristic of these diseases.

Infectious Diseases

Skin biopsies can determine the causative organism of infections caused by bacteria, fungi, or viruses and guide appropriate treatment. This includes conditions like cellulitis, fungal infections, and viral warts.

Skin Cancers

Skin cancers, including basal cell carcinoma, squamous cell carcinoma, and melanoma can be diagnosed via skin biopsies. It provides definitive evidence of malignancy, the type of cancer and its extent for staging and treatment planning.

Rare Skin Disorders

Rare and complex skin disorders like pemphigus, dermatomyositis, and cutaneous lymphomas can be diagnosed using skin biopsies when clinical presentation is insufficient.

Uses of Skin Biopsies

Skin biopsies are used by dermatologists for many purposes, including:

  • Pathology Reports: They detail the microscopic findings of the skin sample taken from biopsies, including information on the type of cells present, their arrangement, and any abnormalities.
  • Diagnosis Confirmation: Biopsy results help confirm or rule out the suspected diagnosis to decide the subsequent course of treatment. Specific patterns in skin cells indicate cancerous changes, infection, or inflammatory processes.
  • Grading and Staging of Skin Cancers: Information on the grade and stage of skin cancer, the depth of tumour invasion and the presence of atypical cells can be provided via biopsies.
  • Guiding Treatment Decisions: The information from biopsy results guides the dermatologist in selecting the most appropriate treatment for the patient.
  • Monitoring Disease Progression: Repeat biopsies may be used to monitor disease progression or the effectiveness of the treatment in chronic or recurring skin conditions.

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