The short answer
A basal cell and cutaneous squamous cell skin cancer evaluation may include skin examination and biopsy. The goal is to confirm the exact diagnosis and gather information that changes care.
Evaluation may include skin examination and biopsy.
Not every person needs every possible test.
Planning may depend on type, size, depth, location, recurrence, spread, and immune status.
A specialist review can clarify an uncommon or unexpected diagnosis.
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The full explanation.
Why a spot gets biopsied
Basal cell and cutaneous squamous cell skin cancers usually announce themselves on skin that has had a lot of sun. The National Cancer Institute describes basal cell carcinoma as "a raised bump that looks smooth and pearly," or as a spot that looks like "a scar or it is flat and firm and may be skin-colored, yellow, or waxy." It shows up most often on sun-exposed areas, especially the nose. Squamous cell carcinoma more often "looks like a firm red bump" that "may feel scaly, bleed, or form a crust," on places like the ears, the lower lip, and the backs of the hands.
Other changes that get attention include "a sore that does not heal" and areas that are "raised and red or reddish-brown" or "scaly, bleeding, or crusty."
Your clinician starts with a skin exam: "an exam of the skin for bumps or spots that look abnormal in color, size, shape, or texture." An exam alone cannot confirm cancer. Only a biopsy can.
What a skin biopsy involves
A skin biopsy removes tissue so it can be "viewed under a microscope by a pathologist to check for signs of cancer." NCI describes four ways this is done:
- Shave biopsy. "A sterile razor blade is used to 'shave-off' the abnormal-looking growth."
- Punch biopsy. "A special instrument called a punch or a trephine is used to remove a circle of tissue" from the growth.
- Incisional biopsy. "A scalpel is used to remove part of a growth."
- Excisional biopsy. "A scalpel is used to remove the entire growth."
It is fair to ask which one is planned for you and why, since some remove a sample and some remove the whole lesion.
What the pathology report will say
The pathologist writes a report describing "the characteristics of a tissue specimen that is taken from a patient." It typically reaches your doctor "within 10 days after the biopsy or surgery is performed."
The report has predictable parts. Identifying information records your name, birthdate, biopsy date, and where on your body the sample came from. The gross description records "the color, weight, and size of a tissue sample as seen by the naked eye." The microscopic description covers "the appearance of the cells after they have been stained," the tumor grade, the cell types, and whether cancer cells reach the edges of the removed tissue. "Margins are described as negative (or 'clean') when the pathologist finds no cancer cells at the edge." The diagnosis section is the pathologist's summary of everything found.
Read the diagnosis line first. It should name the exact tumor type. Basal cell carcinoma and cutaneous squamous cell carcinoma are different diseases from each other, and both are different from melanoma.
Staging, and when it is not needed
Basal cell carcinoma "rarely spreads to other parts of the body. Staging tests to check whether basal cell carcinoma of the skin has spread are usually not needed." Formal staging applies to cancers of the head and neck and of the eyelid, using stages 0 (carcinoma in situ) through IV, based on tumor size and whether lymph nodes are involved.
For squamous cell carcinoma, outlook depends on the stage of the cancer, whether your immune system is suppressed, tobacco use, and your general health. Treatment choices also depend on the type of cancer, "the size of the tumor and what part of the body it affects," and your overall health.
Getting the slides reviewed again
If you want another pathologist's opinion, your doctor can request "the slides and/or paraffin block from the pathologist" so they can be sent elsewhere. Many institutions, including NCI-designated cancer centers, offer this. A second review often agrees with the first, and that agreement is useful information too.
After treatment
If basal cell carcinoma or squamous cell carcinoma comes back, "it is usually within 5 years of initial treatment." Ask your doctor what skin-check schedule you should follow and who is responsible for it.
Questions worth asking
- Which type of biopsy are you doing, and will it remove the whole spot?
- What exactly did the pathology report name?
- Were the margins negative?
- Do I need any staging tests, or is this a site where staging does not apply?
- Would expert review of the slides change anything?
- How often should my skin be checked from now on, and by whom?
Do not assume that silence means a normal result. Ask who will call you, and by what date.
When to get help sooner
A skin biopsy is minor surgery, and the site needs watching while it heals.
- Call your care team the same day if the biopsy site keeps bleeding after you have pressed firmly on it for about ten minutes.
- Call your care team the same day if fluid coming from the wound turns thick, tan, green or yellow, or starts to smell bad.
- Call your care team within a day or two if redness, swelling or soreness around the site is spreading rather than settling, or if you run a fever.
Sources
- National Cancer Institute. Skin Cancer Treatment (PDQ) — Patient Version. https://www.cancer.gov/types/skin/patient/skin-treatment-pdq
- National Cancer Institute. Pathology Reports. https://www.cancer.gov/about-cancer/diagnosis-staging/diagnosis/pathology-reports-fact-sheet
- MedlinePlus. Skin lesion biopsy. https://medlineplus.gov/ency/article/003840.htm
Words to know
Tap any term to see what it means.
Common questions
What do these skin cancers look like?
NCI describes basal cell carcinoma as a raised bump that looks smooth and pearly, or as a spot that looks like a scar, or is flat and firm and may be skin-colored, yellow or waxy, most often on sun-exposed areas, especially the nose. Squamous cell carcinoma more often looks like a firm red bump that may feel scaly, bleed or form a crust, on places like the ears, the lower lip and the backs of the hands. A sore that does not heal also gets attention.
Can a doctor tell just by looking?
No. Your clinician starts with a skin exam, looking for bumps or spots that look abnormal in color, size, shape or texture, but an exam alone cannot confirm cancer. Only a biopsy can, because it removes tissue to be viewed under a microscope by a pathologist.
What kinds of skin biopsy are there?
NCI describes four. A shave biopsy uses a sterile razor blade to shave off the abnormal-looking growth. A punch biopsy uses an instrument called a punch or trephine to remove a circle of tissue. An incisional biopsy uses a scalpel to remove part of a growth. An excisional biopsy uses a scalpel to remove the entire growth. It is fair to ask which one is planned for you, since some take a sample and some remove the whole lesion.
What will the pathology report contain?
Identifying information, a gross description of the color, weight and size of the sample as seen by the naked eye, a microscopic description covering the stained cells, the tumor grade, the cell types and whether cancer reaches the edges, and then the diagnosis. Margins are described as negative, or clean, when no cancer cells are found at the edge. Read the diagnosis line first: it should name the exact tumor type, and these are different diseases from each other and from melanoma.
Do I need staging tests?
Often not. Basal cell carcinoma rarely spreads to other parts of the body, so staging tests to check for spread are usually not needed. Formal staging applies to cancers of the head and neck and of the eyelid, running from stage 0, carcinoma in situ, through IV, based on tumor size and whether lymph nodes are involved. For squamous cell carcinoma, outlook depends on the stage, whether your immune system is suppressed, tobacco use, and your general health.
Questions to ask your doctor
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Sources last checked: 2026-08-11 what this meansLast updated: 2026-08-11Next planned review: 2027-07-22
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How this page was created
Cancer Explained does not originate medical claims. Every page restates guidance already published by the National Cancer Institute, the CDC, the USPSTF and the FDA, in plain language, with the source cited so you can check the original yourself. AI does the translating and organizing; automated checks test claims, citations, clarity and safety before anything publishes. We do not employ clinicians and do not intend to — our work is translation and navigation, not clinical judgment. Nothing here is personal medical advice, and no page can account for your particular situation.
Editorial status: Source checked — This page was written with AI assistance and checked line by line against the sources listed on it. That confirms the sources support what the page says. It is not a medical review, and it does not confirm the page is complete or right for your situation.
Human medical review: not completed. Pages here are not signed off by a clinician before they publish. That is not an oversight we are quietly working around: we restate published guidance and cite it, so the authority belongs to the source rather than to us, and every page names where its claims come from — you can verify us instead of trusting us. Where a volunteer clinician has reviewed a page, their name and credentials appear on it; where no name appears, no clinician has checked it. We are glad to have reviewers and are recruiting them, and we do not hold pages back waiting for one. Use this site to understand your situation and to ask better questions of the people treating you.
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