What will Happen at my Skin Check at Brisbane City Skin Clinic?
Your skin check will begin with your doctor initially asking you some questions about your skin, your sun exposure and your history of skin cancers. This is mainly to establish what your risk of developing skin cancer is. They will also ask you if you have any particular spots that you are concerned about.
You will then be asked to remove your clothing but leave you underwear on so that the doctor can examine your skin. The doctor will then perform a thorough skin check using a special device called a dermatoscope. This device has a special light and magnifying that allows your doctor to assess each spot accurately and determine if there is any risk of the spot being a skin cancer. Your examination will include looking at all the exposed skin as well as your hands, feet, nails and scalp. You will also be asked if you have any spots under your underwear that you would like to be checked.
On some occasions your doctor will be able to confidently diagnose a spot as a skin cancer and from there discuss the treatment options. On other occasions a biopsy will be required to determine the diagnosis. Most of the time the biopsy will be performed at the same consultation as the skin check.
Types of Biopsies
There are 3 common types of biopsies that your doctor could perform. The aim of a biopsy is to provide a sample to the pathologist so that they can assess the lesion, at a microscopic level, and determine the diagnosis very accurately.
Some biopsies aim to remove just a small amount of the spot but some biopsies aim to remove the whole spot so that the pathologist can assess the whole lesion.
A punch biopsy is a type of biopsy that generally aims to removed just a small amount of the lesion. A specialised circular cutting tool is used for this procedure after a small amount of local anesthetic is injected. This type of biopsy is generally only 2-3mm wide and so no stitches are required. A band aid will be placed on the wound and the wound will heal in about 5-7 days. There is generally no need to keep this dry for more than 12-24hrs. Sometimes a replacement band aid will be required for the day after the procedure. A punch biopsy will generally be performed at the time of the skin check unless you ask for this to be done at a separate appointment. They generally leave little to no scar
A shave biopsy is another type of biopsy that can be performed at the same time as your skin check. After the injection of a small amount of local anesthetic a thin sliver of skin is removed with the concerning lesion and this is sent to the pathologist. Again a band aid will be placed over the wound and these wounds can sometimes take 1-2 weeks to completely heal. They can be a bit “weepy” so you may need to replace the band aid daily for a few days. After the first 12-24hr they can get wet.
Whether your doctor performs a punch biopsy or shave biopsy will depend on the location of the concerning spot and what type of skin cancer your doctor is concerned about.
The other main type of biopsy that is performed is an excisional biopsy. This type of biopsy does aim to remove the other whole spot. This is a much more involved procedure and you will often be asked to make a separate appointment for this. This type of procedure is most commonly performed when your doctor is concerned the spot might be a melanoma. For a pathologist to determine whether a spot is a melanoma or not they need to be able to assess the whole lesion. An excisional biopsy requires more local anaesthetic, often an “elliptical excision” will be performed and stitches will be required to close the wound. This will leave a small scar. You will need to look after the wound more carefully than if you had a punch or shave biopsy, keeping it dry for 2-4 days. Often the stitches used will be all dissolving sutures hidden under the skin that do not need to be removed.
Generally if a biopsy has been performed your doctor will inform you that “no news is good news”. This means that if your biopsy has shown anything at all concerning you will be contacted as soon as possible. This can sometime take up to 7 days. However if the biopsy is all clear you will not uniformly be contacted. You will however be able to call after 1-2 weeks to confirm that the biopsy result was all clear.