Oral biopsy
Choose representative tissue, avoid artefact and provide the pathologist with a precise site and clinical differential. Suspicious lesions need an appropriate pathway.
Understand
A biopsy must sample the question being asked. Incisional and excisional approaches differ by size, suspicion, site and need to preserve diagnostic architecture.
Assess
Describe site and lesion extent, select a representative area, and avoid necrotic or traumatised tissue alone. Check anticoagulation, access and whether an urgent cancer pathway is more appropriate.
Apply
Orient and label separate specimens, minimise crush and thermal artefact, and give clinical history to pathology. Track the report and correlate it with the appearance before closing the case.
Key distinctions
Incisional biopsy samples part of a lesion, whereas excision aims to remove it. The choice depends on size, site, suspicion and the need to preserve anatomical relationships for definitive care. Take tissue at the representative edge of an ulcer rather than necrotic centre alone where appropriate. A negative sample that does not explain the clinical picture is a reason to revisit sampling.
Think through a case
A suspected oral malignancy is sampled only from its ulcerated necrotic centre and returns non-specific inflammation. The sampling strategy has not resolved the clinical question.
The distinction to remember
Do not close a suspicious case on a non-representative benign biopsy; discuss and re-biopsy or refer appropriately.
Test your recall
Why include clinical history on the request form?
Show answer
Histology is interpreted with the site, appearance and differential.