What happens if a skin biopsy is positive?

A skin biopsy is a test that removes a small sample of skin so it can be examined under a microscope. It is done to help diagnose skin conditions. If the skin biopsy results come back positive, it means abnormal cells were found in the skin sample.

What does a positive skin biopsy mean?

A positive skin biopsy means the pathologist found abnormal or atypical cells in the sample. This could indicate a number of skin conditions, such as:

  • Skin cancer – Basal cell carcinoma, squamous cell carcinoma, melanoma
  • Precancerous skin lesions – Actinic keratosis, lentigo maligna
  • Inflammatory skin conditions – Psoriasis, lichen planus, lupus
  • Infections – Fungal, viral, bacterial

The specific diagnosis depends on the type of abnormal cells seen and their pattern of growth. A positive biopsy alone is not enough to make a definitive diagnosis. The dermatopathologist will correlate the histopathology findings with the clinical history and examination.

What’s the next step after a positive skin biopsy?

After getting a positive skin biopsy report, the first step is to schedule an appointment with the dermatologist to discuss the results. The dermatologist will explain what the positive result means specifically for your condition.

Additional tests may be ordered to confirm or rule out a diagnosis. For example, if the biopsy showed malignant cells, imaging tests may be done to see if the cancer has spread. If an infection is suspected, a culture may identify the organism.

For conditions like psoriasis or eczema, no further testing may be needed. The positive biopsy confirms the diagnosis. The dermatologist will then talk about treatment options, like topical steroids, systemic medications, or light therapy.

It’s important to discuss the biopsy results in detail with your dermatologist. Ask any questions you may have about the diagnosis, next steps, and treatment options. Being informed puts you in the best position to take care of your skin.

What if my skin biopsy is positive for melanoma?

Melanoma is a serious form of skin cancer that begins in the melanocytes, the pigment-producing cells. It often first appears as an unusual mole or other skin lesion. A biopsy that shows melanoma cells is cause for concern.

If your skin biopsy is positive for melanoma, your dermatologist will want to determine how far it may have spread. Further testing commonly includes:

  • Imaging tests – CT, MRI, PET scan to look for metastases (spread) in lymph nodes or other organs
  • Sentinel lymph node biopsy – Removes and examines lymph nodes near the melanoma to check for cancer cells

Based on the biopsy results and any imaging or sentinel node biopsies, the melanoma will be assigned a stage. This helps determine treatment options and outlook.

Early stage melanomas confined to the outermost skin layers are highly treatable by surgical excision. More advanced melanomas may require lymph node removal, immunotherapy, chemotherapy, radiation therapy, or clinical trials of new treatments.

With early detection, the 5-year survival rate for melanoma is over 90%. Yearly skin exams and promptly getting new or changing moles checked out are key to finding melanoma early.

What if my skin biopsy shows basal cell carcinoma?

Basal cell carcinoma (BCC) is the most common form of skin cancer. It starts in the basal cells within the outermost skin layer. BCCs often appear as open sores or red patches on sun-exposed areas like the face and neck.

If basal cell skin cancer is found on a biopsy, treatment involves removing the cancerous cells. Options may include:

  • Excisional surgery – Cutting out the BCC and some surrounding healthy skin
  • Mohs surgery – Removing thin layers of skin and examining until all cancer cells are gone
  • Cryosurgery – Freezing the cancer cells with liquid nitrogen
  • Topical creams – Medication applied to kill cancer cells for very early stage BCCs

Determining the appropriate treatment depends on the size, location, and depth of the basal cell carcinoma. The cure rate for BCC is nearly 100% if caught early. Regular skin self-exams and dermatology visits help find BCCs when they are highly treatable.

What happens if my skin biopsy shows squamous cell carcinoma?

Squamous cell carcinoma (SCC) starts in the squamous cells that make up the outer layer of skin. It may appear as a growing bump, lesion, or sore anywhere on the body.

If a skin biopsy confirms squamous cell cancer, treatment will be done to remove or destroy the cancerous cells. As with BCCs, options include:

  • Excisional surgery
  • Mohs surgery
  • Cryosurgery
  • Radiation therapy
  • Topical creams for very superficial SCCs

In determining the best course of treatment, the dermatologist will consider the location, size, and depth of tumor penetration. Catching SCC early makes cure rates very high.

SCCs mainly occur on frequently sun-exposed areas. Reducing sun exposure and getting suspicious spots examined promptly are important preventive steps.

What if my biopsy shows actinic keratosis?

Actinic keratoses, also called solar keratoses, are rough, scaly patches on the skin caused by years of sun exposure. They form in the outermost skin layers and are pre-cancerous lesions that can sometimes progress to squamous cell carcinoma.

A skin biopsy that shows actinic keratosis reflects sun damage. Treatment options aim to remove the lesion and affected skin layers:

  • Cryotherapy – Freezing with liquid nitrogen
  • Surgical removal – Cutting out lesion and small margin of healthy skin
  • Topical medications – Prescription creams that peel off lesions
  • Laser therapy – Using focused light beams to vaporize lesions
  • Photodynamic therapy – Applying a light-sensitive chemical and activating with light

If actinic keratoses keep coming back, your dermatologist may recommend more frequent skin exams to monitor for any progression to skin cancer. Preventing further sun damage through sunscreen, protective clothing, and avoiding midday sun can help control actinic keratoses.

What does it mean if my skin biopsy shows psoriasis?

Psoriasis is an autoimmune condition causing buildup of scaly, inflamed skin patches. It most often occurs on the knees, elbows, trunk, and scalp. A skin biopsy can help confirm a psoriasis diagnosis by showing characteristic microscopic features:

  • Thickened epidermis with thick scale buildup
  • Reduced or absent granular skin layer
  • Increased number of dividing basal cells
  • Inflammatory cells in the dermis

There is no definitive cure for psoriasis, but many treatment options can effectively control symptoms. After a confirmatory biopsy, your dermatologist will likely recommend topical medications, light therapy, or systemic drugs to reduce inflammation and scales.

With continued treatment and avoidance of psoriasis triggers, many find their psoriasis goes into remission. Even when not completely clear, keeping plaques under better control greatly improves comfort and quality of life.

What are the risks of a skin biopsy?

A skin biopsy is considered a very safe procedure when performed properly by a dermatologist. Still, as with any medical procedure, there are some risks including:

  • Pain – A local anesthetic is used to numb the area first. There may be some mild discomfort during the procedure.
  • Bleeding – A small amount of bleeding is common. Applying pressure stops it quickly.
  • Infection – Rare. Keeping the biopsy site clean helps prevent infection.
  • Scarring – Can happen but is uncommon, especially if wound care instructions are followed.

Be sure to talk with your dermatologist about any concerns you may have about possible risks before getting a biopsy done.

How should I take care of my skin after a biopsy?

Following your dermatologist’s instructions carefully after a skin biopsy promotes fast, proper healing and reduces risks like infection or scarring.

Typical wound care guidelines include:

  • Keep the biopsy site covered with a bandage for 24 hours.
  • Follow any additional bandaging or dressing instructions from your dermatologist.
  • Avoid getting the biopsy site wet for 1-2 days.
  • After bandage removal, keep the area clean and dry.
  • Apply an antibacterial ointment like petroleum jelly daily for 3-5 days.
  • Take over-the-counter pain medication as needed for discomfort.
  • Call your dermatologist if you notice increasing pain, redness, swelling, oozing, or warmth at the biopsy site.

Most small skin biopsy sites heal within 7-10 days without any issues by keeping the area protected until healed.


A positive skin biopsy means abnormal cells concerning for conditions like skin cancer or infections have been detected. Your dermatologist will explain what the findings specifically indicate for your health.

Depending on the results, your doctor may recommend additional testing, imaging, or biopsies to confirm a diagnosis. Treatment options will also be discussed to remove any cancerous tissue or otherwise address the skin condition.

Although positive biopsy results may be unsettling, keep in mind most skin conditions are very manageable if caught in early stages. Following your dermatologist’s advice for further evaluation and treatment will ensure you get on the right path towards healthy skin again.

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