A Biopsy Is Almost A Guarantee Of Cancer Metastasis & Acceleration.
Dr Thomas Lodi, MD
The Problem With The Biopsy Is This. When A Cancer Tumor Is Growing, The Body Contains it Within A Fibrin Sheath.
The Minute That Sheath Is Broken, By The Puncture Needle Of A Biopsy, The Cancer Metastasizes &
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They don't do needle biopsies.
Melanoma & Squamous Cell : complete wide excision only. (for that reason)
I think they do either incisional biopsies, or excisional biopsies depending on the size of the lesion. One would hate to do a wide excision, say remove half a lip or a large area requiring a skin flap or skin graft only to find out it wasn't cancerous. Needle biopsies are traditionally for deep lesions, below the skin. Seeding was always a concern, but how else do you know what the tumor or lesion is? That's how I was trained anyway. Perhaps they have newer ways to find out. I retired 10 years ago so maybe things have changed for the better.
So you are saying that the incisional biopsies are spreading disease as well ?
My first tumor removal I was on my own , the attending said no big deal. 3 instruments . Scissors , tweezers and a scalple plus the local anesthetic. After I got the original target plus another 1 1/2 inch of the attached tail . A nursing student was helped away and the attending excitedly returned. The # 2 guy in the Pathology Department. Wanted to know what I was doing. Remember I didn't have a hemostat or even locking pliers. I didn't look up , " What you told me to do , but it's not going as you suggested" . He looked in and told me to cut it , I resisted. I lost.
Adenocarcinoma , without a clear margin. The hospital had a surgeon remove most of the lower lip.....I didn't know until after from my own research that this tumor can reoccur but very rarely metastasizes. Removing half + of his lip was of no concern to the Hospital.
You go in prepared to remove it all. They don't do frozen sections because the bastards are too cheap to keep the facilities and a pathologist on staff & tie up the surgical suite while they wait for results. So they are willing to spread it just like the needle biopsy. To save a buck.
No,I was saying you need to diagnose it before you go cutting it out so that you know what kind of margins one needs to make around the lesion. If is it malignant you will likely be removing that area anyway. So if you have a large lesion on the skin an incisional biopsy is required. If you have a deep lesion a needle biopsy seems in order. If the lesion is in bone and is large a biopsy must be done so you would know weather to curette the lesion out or do a wide resection of bone that would also require reconstruction (plating, bone grafts, etc.). You don't just go in willy nilly as if you have microscopic eyes and know what you are removing. You can guess but that is not very accurate and may be irresponsible leading to malpractice. Sometimes frozen sections are indicated when doing a wide resection and you're looking for clean margins in a hospital setting. Most lesions are biopsied in the office to determine their nature. If non malignant a simple excision can be done in the office if not of considerable size. If malignant then a partial lip removal, or wide excision would be done in the hospital, likely with frozen sections. This must be scheduled also with the in hospital pathologist so that he/she is prepared for the procedure. Personally I wouldn't mess with an adenocarcinoma, I would be sure to get it all. I practiced 30 years as an Oral & Maxillofacial Surgeon and kept up with all the latest recommendations and standards of care, operating both in office and in hospital settings. I hope I knew what I was doing all those years. Never lost a patient and never got sued.
Maybe thinking about your thinking is in order. But your training is accurate.