At the SKIN doctor we use a very advanced dermatoscope. This hand held microscope magnifies the lesion, but because of its polarized light it can also see into the different layers of the skin. In these deeper layers an experienced doctor with special training can find clues for skin cancer, or can confidently rule out skin cancer.
Sometimes even after the dermatoscope exam it is not certain whether or not the lesion is skin cancer. The doctor may need to take a little bit of skin away to send to the laboratory. This skin can be punched out with a very small (3-5mm) apple bore like device, or can be shaved off with a razor like knife. Sometimes it is easier to just remove the full lesion with surgery: “When in doubt, get it out.”
The skin that is removed during a procedure will always be send to the lab for further examination.