Biopsy Procurement Guidelines

The following guidelines are intended to guide medical professionals in properly preparing biopsies for sending to our lab

Types of biopsies
  • Incisional biopsy: Sampling a portion of the lesion with a scalpel wedge incision or a punch.
  • Excisional biopsy: Surgical removal of the entire lesion.
Selecting a site
  • For red, white and pigmented lesions, a biopsy can be taken anywhere within the lesional area.
  • For bullous/erosive lesions, take an elliptical wedge incisional biopsy to include the lesion and a portion of normal adjacent tissue.
  • Large masses: Take an incisional biopsy by obtaining a deep wedge, about a centimeter deep.
  • Small masses: Excise the entire mass.
  • Mucoceles: Include underlying glands to avoid recurrence.
  • Gingival masses: Excise and perform thorough root planning.
  • Ulcers: Small ones can be excised, Large ulcers should have an elliptical incision into the ulcer bed with inclusion of adjacent normal tissue.
Margins

Orient the specimen for anterior (or superior), posterior (or inferior), left margin, right margin. Place a short suture in the anterior (or superior) margin and a long suture in the right margin (or use one gut and one silk).

Do not use laser or cautery on epithelial lesions where dysplasia is expected. The artifactual changes can be severe and no diagnosis can be given.Use scalpel or punch, and after the tissue is removed, laser or cautery to the wound site can be applied for hemostasis.