What is an excisional biopsy?

An excisional biopsy is a type of surgical procedure in which the entire abnormal area of tissue is removed so it can be examined under a microscope by a pathologist. Unlike other types of biopsies that only take a small sample, an excisional biopsy removes the whole lump, lesion, or suspicious area. This enables the pathologist to examine the entire specimen and provide the most comprehensive diagnosis possible.

Why is an excisional biopsy performed?

An excisional biopsy is performed when a doctor wants to completely remove an abnormal area for both diagnostic and therapeutic purposes. For example, if a patient has a small skin lesion, a breast lump, or a lymph node that looks unusual on imaging, removing the whole area allows the pathologist to determine precisely what it is. In many cases, an excisional biopsy can also be curative if the abnormality is benign (noncancerous).

What does the pathologist look for?

After the tissue is removed, it is sent to a laboratory where a pathologist examines it under a microscope. The pathologist looks for signs of disease, such as:

• Whether the tissue is benign (noncancerous) or malignant (cancerous).

• The exact type of tumor or disease present.

• Other important features, such as whether the tissue was removed entirely.

The pathology report will often include information about the margins, which are the edges of the tissue. Margins are important because they indicate whether all of the abnormal area has been removed or if some of it may remain in the body.

How is this different from other types of biopsies?

• In an incisional biopsy, only a small piece of the abnormal area is removed for diagnosis, not the entire lesion.

• In a core needle biopsy, a thin, hollow needle is used to extract small cylindrical tissue samples.

• In a fine needle aspiration (FNA), only a few cells are removed with a very thin needle.

An excisional biopsy differs because the entire area is removed, providing the pathologist with more tissue to examine and often eliminating the abnormal area.

What happens after an excisional biopsy?

Once the pathologist has studied the tissue, the results are sent to your doctor. If the abnormal area was benign and completely removed, no further treatment may be needed. If it was malignant, additional treatment may be recommended depending on the type of cancer, its size, and whether any tumor cells were seen at the margins.

Questions for your doctor

If you have had an excisional biopsy, you may wish to ask your doctor the following questions:

• Was the abnormal area benign or malignant?

• Were the margins clear, or is there any tissue left behind?

• Will I need more surgery or additional treatment?

• How often should I return for follow-up after this procedure?