South Texas ENT Consultants, PA
In Office Procedures - Details
Biopsies are performed by excising a sample portion of a tumor or suspicious lesion. Biopsies are usually performed for unusual growths, lesions or areas that do not heal, or to determine a course of treatment. Many biopsies can be performed under local anesthesia in the physician’s office. The biopsy of tumors in deeper regions of the neck and throat are done under general anesthesia in the operating room with the use of an endoscope. Biopsies may take the form of a needle aspiration, an incision, a shave biopsy, or an excision.
Needle biopsies are typically performed in the office setting with a small needle. The procedure is sometimes referred to as a fine needle aspiration. A needle is injected into a mass and cells are removed and put on a glass slide for a pathologist’s microscopic examination and identification. Needle biopsies may be performed on masses in the soft tissues of the head and neck, as well as on glands such as the thyroid or salivary glands or on lymph nodes. A needle biopsy is limited in its accuracy by the surgeon performing the procedure, the technical preparation, and the size of the lesion. The bigger the size the less accurate the results may be. In addition, certain glands or masses are less amenable to needle biopsy.
An incisional biopsy is performed when a small portion of the lesion or growth is removed. Sometimes this is in the form of a shave biopsy, as from the skin. In addition, if a lesion is quite large, a small portion of it may be removed to determine its nature so that a course of treatment can be determined.
An excisional biopsy removes the entire lesion and the surrounding tissue, all of which is sent to a pathologist for microscopic examination. Lymph nodes are typically excised in their entirety after a preliminary needle biopsy. Some excisional biopsies, such as in the thyroid may involve the entire gland. Most biopsies are performed in the office but some are performed at the hospital or in a hospital setting. This may include outpatient or inpatient procedures depending on the location and nature of the lesion.
Removal of Superficial Skin Cancers
The most frequent type of skin cancer is basal cell carcinoma. This cancer is slow growing and rarely metastasizes (spreads). Squamous cell carcinoma can involve both the skin and mucous membranes. Squamous cell carcinoma often extends deeper into the tissue and can ulcerate and metastasize. Surgical removal is the treatment of choice. Malignant melanoma is the most serious of skin cancers and is known for its invasiveness and metastatic behavior. Prognosis is dependent on the depth of the tumor. Therefore, detection and removal are critical.
There are several effective methods for the removal of skin cancers. However, the method chosen will depend upon the type of cancer, its location and size, and any previous therapy for skin cancer.
- Freezing - Certain skin cancers can be destroyed by freezing the lesion with liquid nitrogen. Once the dead tissue thaws, it will slough off. This treatment may leave a small, white scar and the procedure may need to be repeated to remove the growth completely. If skin cancer treated with liquid nitrogen does not heal within one month, the cancer may extend beyond the area treated requiring a biopsy for further evaluation.
- Excisional Surgery - With this type of treatment, the physician cuts out the cancerous tissue along with a surrounding margin of healthy skin. The entire specimen is then sent to a pathology lab to determine if the margins are free of malignant cells, (i.e., no cancerous cells are present in the skin surrounding the cancerous growth). This type of treatment may be appropriate for any type of skin cancer and typically has a higher success rate than freezing.