Tongue Biopsy

The case

A tongue biopsy takes tissue from a sore, patch or lump on the tongue so it can be examined under the microscope. Lesions that have lasted two weeks or more are usually biopsied, and the sides and back edges of the tongue get special attention because that is where tongue cancer most often starts. The biopsy is done through the open mouth, usually with local anesthetic, and it is often an outpatient or office procedure.

There are two kinds of biopsy. An excisional biopsy removes a small, harmless-looking lesion completely. An incisional biopsy takes only a sample, and it is the usual choice when cancer is suspected, so the edges of the lesion stay in place for the cancer team to plan the definitive operation. The sample is taken with a round punch (3 to 5 mm) or with a #15 scalpel. A punch is quick and gives fewer crush marks in the tissue; a scalpel wedge shows how deep a tumor goes. A brush biopsy only scrapes off surface cells and does not replace a tissue sample.

What sets a tongue biopsy apart from a skin biopsy is control of the tongue: it is a strong, slippery muscle in a small, wet space. The surgeon holds it with gauze, a chalazion forceps or traction stitches, and the scrub needs suction and retraction ready. Handling of the specimen matters just as much, because crushing, heat and too much injected fluid can all leave the tissue unreadable. Possible problems afterward include bleeding, pain, swelling, infection and, at times, numbness or other nerve injury.