Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Key indications for performing a skin biopsy in primary care include:
- Suspicion of melanoma or other skin cancers, particularly when a lesion shows asymmetry, border irregularity, colour variation, diameter enlargement, or evolving characteristics, warranting histological confirmation NICE NG14.
- Uncertain diagnosis of atypical or persistent skin lesions that do not respond to initial treatment or have unusual features, to establish a definitive diagnosis and guide management NICE NG14.
- Lesions suspected to be inflammatory or infectious dermatoses where clinical examination alone is insufficient to differentiate between conditions, and biopsy can clarify diagnosis Alguire & Mathes 1998.
- Evaluation of chronic or progressive skin conditions where malignancy or other serious pathology cannot be excluded clinically, necessitating tissue diagnosis NICE NG14.
- When referral to secondary care is delayed or not immediately available, performing a biopsy in primary care can expedite diagnosis and treatment decisions Alguire & Mathes 1998.
Overall, the decision to biopsy in primary care should be guided by clinical suspicion of malignancy, diagnostic uncertainty, and the potential impact on patient management, balancing the need for timely diagnosis with procedural expertise and resources NICE NG14 Alguire & Mathes 1998.