Biopsy

A biopsy is a small sample of the lining of the mouth, nose, skin or ear. Biopsies may be used to determine the cause of lumps, ulcers or red and white patches. Biopsies are usually done with the patient awake and sitting upright. The practice nurse assists the surgeon. The whole procedure takes 30 minutes or so, including ten minutes resting and observation time at the end of the procedure.

Making the area numb first

Anaesthetic medication is used to make the area numb before the biopsy is taken. We start with spray or ointment anaesthetic then use a local anaesthetic injection. For biopsies of the nose, the anaesthetic is sprayed on and tastes bitter (Cophenylcaine). It takes 2-5 minutes to work. For biopsies of the mouth, lips and tongue the anaesthetic is rubbed on (Lignocaine ointment). This takes 2-5 minutes to work and is tasteless. For biopsies of the skin and ear, an anaesthetic cream is applied (Angel or Emla). This takes 45 minutes to work. Once the topical or surface anaesthetic has made the area numb, you may then have a small injection of local anaesthetic to deepen the numbness. This injection contains Lignocaine and Adrenaline. It works within a few minutes and lasts for a couple of hours. It does not cause sedation. You will be able to drive and return to work on the same day.

Taking the biopsy

There are three ways to take a biopsy:

  • Punch biopsy: a small round device that looks like a pen is used to drill a small circle. Punch biopsies can be as small as 2mm in size. No suture is required and the area heals within 48 hours.
  • Scalpel biopsy: a scalpel or surgical knife is used to cut a sample. Sutures are usually required and the area heals within 4 days. The sutures are dissolvable and do not need to be removed.
  • Through-cut biopsy: a device like a pair of tweezers is used to cut a small piece of tissue. No sutures are requiring and the area heals within 48 hours.

After the biopsy is taken, pressure is applied to the area for 2 minutes to stop bleeding. Some patients feel dizzy or faint after procedures. If you know this happens to you, let us know and we can lie you down during the procedure. You will be observed for ten minutes by the practice nurse. You will be able to drive home from the appointment and return to work on the same day.

After the biopsy

The sample is sent to a specialist called a Pathologist. The Pathologist examines the specimen and issues a report. The report is usually available in 2-3 days. You will have another appointment to discuss the results with the surgeon and check on healing.

You will have mild pain at the biopsy site for 24 hours. Bleeding may occur and is usually easily controlled by pressing on the area firmly for two minutes. You can eat and drink as normal. Please contact the practice nurse if you have severe pain or pain lasting longer than 24 hours or if there is bleeding not easily controlled by pressure.

Fine needle aspiration cytology (FNA)

Lumps deep to the skin can be sampled with a fine needle. This is less invasive than cutting through the skin to take a sample. The test is similar to a blood test. Instead of drawing blood from a vein the needle draws cells from a lump.

Making the area numb first

The skin is usually made numb before the sample is taken. This can be done with a surface or topical anaesthetic cream like Emla or Angel cream (45 minutes to work) or a local anaesthetic injection (5 minutes to work).

Taking the sample

The skin is wiped with an alcohol swab. A small needle is passed into the lump. The cells are then sprayed onto a glass microscope slide. More than one needle sample may be required. Pressure is then applied to the site for 2 minutes. There is usually no pain after the sample is taken. Bleeding can occur and is usually controlled by firm pressure for 2 minutes. A small bruise may occur.

If a lump is difficult to feel, the FNA may be done by a specialist called a radiologist. The radiologist uses an ultrasound to locate the lump and then passes the needle into the lump while watching the ultrasound image on a screen. This allows a very accurate sample to be taken.

After the FNA

The sample is sent to a specialist called a Pathologist. The Pathologist examines the specimen and issues a report. The report is usually available in 2-3 days. You will have another appointment to discuss the results with the surgeon.