Oral Cavity Biopsies: 3 Do’s and 3 Don’ts

My first biopsy was misread as hyperkeratosis when in fact it was moderate dysplasia. I should have been flagged two years before I was diagnosed with Stage IV Squamous Cell Carcinoma on the lateral border of my tongue. Here is what I learned about biopsies: They are not 100% definitive. Why? Imprecise tissue sampling; Improper tissue handling; inaccurate interpretation.

I complained for nine months about the pain from the lesion on the lateral border of my tongue (which has reappeared two years after it was originally removed. The biopsy was never questioned. In fact, my treatment plan was based on a two-year old biopsy. If someone continues to complain beyond two weeks, the lesion should be biopsied. It must be read by an oral pathologist (graduate of a dental school) instead of a general pathologist (graduate of a medical school).

If you want a little more detail about oral cavity biopsies, these are the three Do’s and 3 Dont’s:

  • Do immerse the lesion immediately in sufficient volume of fixative
  • Do handle the lesion gently — crushing the lesion may limit our ability to diagnose the lesion
  • Do incise deep enough, especially if you are dealing with a raised leukoplakia – if the sample is not deep enough it may not include the bottom of the epithelium which may mean a diagnosis of dysplasia, or worse, is missed


  • Don’t incise a small lesion — excise it instead
  • Don’t inject local anesthetic solution into the immediate area — it can distort the tissue making microscopic examination difficult
  • Don’t use cautery or lasers if you suspect dysplasia, cancer or inflammatory lesions — they cook tissues and we may not be able to provide an accurate diagnosis

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