Frequently Asked Questions about a dermatology skin or mole biopsy by the team at Mosaic Dermatology Houston.
What is a skin biopsy?
A biopsy is the removal of a small part of a skin lesion (a skin growth or a rash) preformed by a Dermatologist. The size of the removal will depend on the type of skin condition you have. Often the size does not exceed 2 to 7 mm in width, depending on how large of a problem area we are testing. This is about the size of a pencil eraser.
The depth of the biopsy is also a few millimeters down into the dermis or deep to superficial fat called the subcutaneous fat. The biopsy can be called by different names depending on the type. Some types of dermatology biopsies include a shave biopsy, a punch biopsy, and an extensional biopsy.
The skin tissue being tested in the biopsy then goes to a special lab that may be in Texas or other states. This testing is done for deeper closer analysis under a microscope and involves another skin doctor sub-specialist. This allows a magnified analysis of the skin cells and diagnosis that is provided by the sub-specialist called a Dermatopathologist.
What is the purpose of the biopsy procedure? Why does a Dermatologist do a biopsy?
A biopsy allows your Houston dermatologist to collect a partial sample of skin to send to a laboratory for testing and more extensive evaluation. These tests give us answers beyond what we can see with our eyes in a clinical exam. Once the results are finalized, the next step of treatment can be planned out in more detail. The test can show most infections and cancers.
The next step can be as simple as observation, medications, or may be more aggressive and require a deeper larger surgical procedure.
What is the price of a skin biopsy?
The price of a skin biopsy by a dermatologist is $100 - $400. The average cost of the biopsy depends on the complexity and location of the biopsy. Sometimes insurance will cover the biopsy cost, but often this fee is out of pocket as part of your dermatology deductible. Procedure biopsy fees are also separate from your specialist co-pay.
To understand more about how insurance works for dermatology procedures consider reading and doing research in advance about your deductible.
Are there other costs? Does the cost of the biopsy include the cost of the studies/reports done on the skin sample?
The procedure of a biopsy is billed by the dermatology clinic. The results are then prepared by a laboratory which often bills separately from the Houston Texas clinic. The laboratory has a separate doctor look over the sample to provide results. Patient's do not see this laboratory or doctor, but they do bill for the services that they provide on preparing and diagnosing the biopsy tissue. This cost can be another few hundred dollars
How much is a skin biopsy without insurance?
The typical cost of a skin biopsy without insurance is $120 - $450. Lab evaluation fees may add extra fees from $50 - $350.
Must the biopsy be done, even if we think we know what I have?
This all depends on your medical skin condition. In some situations, a clinical visit can provide you with an answer based on expert opinion that is nearly always correct. However, in other situations, histologic confirmation by biopsy is required for the continued management of your skin condition. It is important to also understand that a biopsy will increase your odds of an answer with the results provided, however even a biopsy is not always 100% correct every time.
Why not completely remove the skin growth (mole or cancer) now, and skip the skin the biopsy?
Removing a skin lesion based on what we can see in clinic can be a challenge. This is because most skin lesions have microscopic extensions (roots) not visible to the eye in clinical exam, and which can extend unpredictably. Also, it is hard for the eye to determine how severe the condition is without a biopsy.
So the biopsy gives us a lot of information about your mole or skin condition.
-The biopsy gives us a preliminary idea of how serious the problem is.
-How far the skin issue potentially extends.
-A more accurate diagnosis.
Thus, with more information, we can offer better treatments. We can then take the next step based on national guidelines. The resulting national clinical guidelines have been established to determine how much extra "normal" appearing skin should be remove beyond the visible lesion. These guidelines are designed by national experts to try and assure removal of all the extensions(roots) that may exist. However, most lesions have different clinical guidelines based on what the exact lesion is, and we have to do a biopsy to confirm the type of lesion and thus the specific clinical guidelines that should be followed.
Can a biopsy be negative?
Yes, sometimes a biopsy lets us know that no further steps need to be taken and a full removal can be avoided. This prevents unnecessary scars or other potential complications that can occur with full removal. If you have negative results, that is great. However, remember to always practice sun protection to help minimize the chance of future skin cancers.
Also, a biopsy often results in an extra charge, even with most insurance plans, if you have not met your annual deductible of spending.
Can a biopsy be wrong?
Yes, skin biopsies are like all medical tests. They are not 100% accurate and sometimes a repeat test is needed. Also, skin evolves with time and a repeat test days, weeks, months, or years later may show different results. A biopsy is often helpful, but is not always the best option for everyone.
Is a skin biopsy painful?
Each person has a different level of tolerance to pain. We make every effort to keep you comfortable and prepare you for the procedure. This includes using local anesthetic to numb the area. In most situations, the only uncomfortable sensation is the one you feel during the initial seconds that it takes to numb the region with anesthetic medication such as Lidocaine. Most of our Houston patients are able to drive home right after the procedure.
Should I stop my blood thinners, asprin, or any other prescribed medications?
No, you will not have to stop or skip a dose of any of your medications.
Should I fast or not eat before the procedure?
You can continue all your daily routines as usual. You do not need to fast in most cases.
How long does the procedure take?
A skin biopsy is a same day clinical procedure. Even walk in patients can get them done the same day in most situations, but calling for an appointment is not a bad idea. Further treatment steps may be required after the results of the biopsy return. These extra steps may require more time. Please note, some insurance plans do not cover same day procedures and require advance planning and return visits for procedures.
Will the procedure leave a scar?
Every person is unique and the degree of scar may vary. Many people have almost no visible scars after a biopsy, while others may develop hypertrophic scar or color changes at the site of the procedure. Often, scar can be minimized by practicing sun protection and keeping a band aid on the procedure site until it is fully healed.
For facial scars you can reduce scars with regular sunscreen application. Further use of premium Vitamin A cream could also be advantageous.
Do I need to do anything special for the wound?
It is good to keep white petrolatum ointment on the wound to help with healing. Wound care instructions: Antibiotics such as Neomycin are often not required unless you have been specifically instructed to use them and/or you are prone to infection, or have immune system problems, or other medical conditions
Cosmetically sensitive sites may need extra steps for improved healing. Using daily sunscreen and a nightly Vitamin A cream can be especially beneficial.
When will the results return?
Results return within a few days. Results rarely, if ever, take more then 10 business days to return. If you have not heard back regarding your results, it is best to contact the dermatology clinic.
Do not see your question answered?
Contact us to add it to the list. As part of his training at the world renowned MD Anderson Cancer Center, Dr. Rashid has preformed over 1,000 skin biopsies. And we also offer Saturday clinics for those not able to go in for biopsy testing on a weekday.
And remember to be prepared for your visit. This can help a great dermatology experience become the best dermatology visit.