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Biopsy: Improving the Diagnosis

Figure 1, melanoma under the microscope

Figure 1, melanoma under the microscope

For as long as I can remember, I have wanted to be in the medical field. When I was younger, I didn’t like it when the doctor didn’t have the exact diagnosis. When there was any ambiguity, I felt cheated. When I visited a podiatrist, I thought I found the perfect doctor. Each time I needed to be seen, whether it was an ingrown toenail, or a broken foot bone (this happened twice!), the podiatrist had the answer. After going through podiatry school and residency, I learned there were some diagnoses that were very straight forward, but there remained, just like in any specialty, scenarios where the answer is not as discernable by clinical findings and/or an x-ray. I have come to grips with the uncertainty, because there are ways in which to improve the diagnosis, one of which is through biopsy.

For skin conditions, different disease processes look the same, but have different treatments and outcomes. In many instances, further investigation is required. For dermatologic conditions, this is done by biopsy. With very simple techniques, any “guesswork” can be eliminated and patient mismanagement can be avoided(1).

What is a biopsy?
A biopsy is any sample of tissue that is removed from the body that is then sent to be examined more closely. The specimen is sent to a laboratory to be prepared for further examination. Usually, this examination is performed by a pathologist, a doctor who specializes in the cause and effect of diseases. The sample is prepared in wax and cut into small sections of 3-4 microns, placed on a slide, and then stained with special chemicals that allow different cells to be seen under the microscope.

Figure 2, a mole or 'nevus' under the microscope

Figure 2, a mole or ‘nevus’ under the microscope

A “micron” is an abbreviated term for “micrometer”, or a millionth of a meter (1/1,000,000 meters). This is about 0.00004 inches. For Size comparison, a human red blood cell is about 5 microns across. A human hair is about 75 microns across (depending on the person)(2).

Why do I need a biopsy
Taking a small sample of a larger problem allows for a more specific and accurate diagnosis and therefore, more precise and timely treatment. For example, Athlete’s foot, psoriasis, and eczema can all have a similar appearance. Melanoma, a deadly skin cancer, has the look of a mole to the untrained eye. Telling the difference between a benign acral melanosis (increased pigmentation found in some skin types), and melanoma is not possible without the assistance of the pathologist. With the correct diagnosis confirmed through biopsy allows the clinician then prescribe the correct treatment.

1. Podiatric Dermatology: An Evidence-Based Approach
1. Researchgate – Acral lentiginous melanoma in situ
2. Wikipedia – Dysplastic nevus