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What is an Excisional Biopsy?

By A. Gabrenas
Updated Mar 03, 2024
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An excisional biopsy is a surgical procedure commonly used to remove a piece of tissue that shows sign of possibly being cancerous. For example, it may be used to test abnormal lumps of breast tissue or suspicious moles. It is generally considered one of the more invasive diagnostic tests, often requiring stitches and leaving a scar. While initially diagnostic, an excision biopsy can also be curative if all abnormal cells are successfully removed during the primary procedure.

There are several different types of biopsies that are commonly used to diagnose abnormal masses and skin lesions. One of the simplest and least invasive of these is a needle biopsy, where a needle is inserted into the mass and a small piece of tissue is removed. This is a type of incisional biopsy, meaning only part of the mass is removed.

An excisional biopsy, on the other hand, removes the entire affected area. For a larger mass, such as a breast tumor, the procedure is often conducted in a hospital and requires either local or general anesthesia. Such a procedure generally requires stitches to close the wound, and may leave a noticeable dent or dimple where the mass was removed. Even for smaller lesions, such as suspicious moles, stitches are often needed and a small scar is typically left behind where the skin has been removed.

Due to the fact that excisional biopsies are a form of surgery, there are often some risks involved. Risks include those from the anesthesia used, as well as the wound created by the tissue removal. Depending on the exact type used, anesthesia can lead to problems such as difficulty breathing, nerve damage, and nausea and vomiting. Risks related to the tissue removal itself include excessive bleeding, infection and development of abnormal scar tissue. In general, however, healthcare providers only recommend excisional biopsy when the benefits outweigh the risk.

When the tissue is removed in any kind of biopsy, it is generally sent for further testing to determine what type of cells are present. A pathologist typically views the cells under a microscope, often treating it with special chemicals to highlight any abnormalities. If precancerous or cancerous cells are found, the patient and specialist will usually then discuss options for further treatment, if needed. In some cases, such as precancerous moles, the excisional biopsy may have removed enough tissue that no additional treatment is needed. Other cases, however, may require additional surgery, chemotherapy, radiation or other treatment to ensure all of the abnormal cells are eradicated.

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