If all the spots are similar looking then it makes sense to biopsy any one of them to reach a diagnosis. You dont need to biopsy all of them. However if they are different and all have a suspicion of cancer based on clinical examination then all need to be biopsied. This only your clinician can tell. The treatment of course will depend on the biopsy result which you havent mentioned.
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What Causes Dark Black Spots On Inner Labia And Anal Region?
If all the spots are similar looking then it makes sense to biopsy any one of them to reach a diagnosis. You dont need to biopsy all of them. However if they are different and all have a suspicion of cancer based on clinical examination then all need to be biopsied. This only your clinician can tell. The treatment of course will depend on the biopsy result which you havent mentioned.