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An incisional biopsy will provide a larger tissue sample for histopathological examination compared to a needle core biopsy. Biopsy samples from both the central area of the skin mass, as well as at the margin between tumor and normal skin are recommended to assess local invasiveness. The biopsy tract should be planned so that it is in a location that can be excised with the definitive surgery. Contamination of normal tissues with tumor cells during biopsy can occur and result in local recurrence if the biopsy tract is not removed (Enneking and Maale 1988; Gilson and Stone 1990). Ideally, the surgeon who will perform the definitive surgical procedure will perform the incisional biopsy. A longitudinal biopsy orientation is recommended for extremity skin tumors, as most masses in this region will be excised with incisions parallel to the long axis of the limb. Histologic grade can differ between incisional biopsy and definitive surgical biopsy with incisional biopsy results more frequently underestimating rather than overestimating grade (Perry et al. 2014; Shaw et al. 2018). Based on these findings, grade as determined by pretreatment biopsy should be interpreted with caution.