- Patient's name, age, unique identifier (DOB, MR#, SS#, etc.), and insurance information
- Precise anatomic site of lesion
- Size of lesion in 2 dimensions, if not completely excised
- Method of biopsy if not obvious (particularly important for incisional biopsy)
- Pertinent historical information (personal or family history of melanoma, personal history of any visceral malignancy, radiation therapy, significant sun exposure, immunocompromised, etc.)
- Pertinent facts regarding the lesion's behavior (recent change in size, shape, color, consistency)
- Any prior treatment of lesion (topical agents, cryotherapy, previous biopsy)
- Clinical impression (ex. "highly suspicious for melanoma")
The list to the right shows several characteristics which would warrant a skin biopsy. These criteria have been shown by many studies to be good indicators of skin malignancy. If a skin growth has one or more of these characteristics, a biopsy or referral to a dermatologist should be considered. Although these characteristics are sensitive predictors of skin malignancy they are not as specific and as a result some benign growths will also be biopsied or referred. In other words, using the criteria in this list you will miss very few skin cancers, but you will end up biopsying or referring a few benign growths.
Another way to tell whether a lesion should be biopsied or referred is if you find yourself doing a double take. This "moment of doubt" that prompts you to reexamine a particular skin lesion (due to pigment, border irregularity, size, etc.) should be the impetus to perform, or refer for, the skin biopsy. This may be the best opportunity to diagnose the patient with early stage skin cancer. While scarring on cosmetically sensitive areas should be acknowledged and discussed with the patient, serious sequelae or morbidity from a skin biopsy is rare.
The benign pathology report should not lead to self-recrimination. In fact, less than one-quarter of all biopsies submitted to pathology to rule out malignancy (such as skin, breast, prostate, and colon polyp biopsies) demonstrate cancer - further evidence that cancer at an early stage is often difficult to distinguish from a benign growth.