Recommended Biopsy Techniques

At Georgia Dermatopathology, our goal is to provide the most accurate diagnosis possible, as quickly as possible. Here are some suggestions regarding biopsy preparation that will help avoid delay and ensure the integrity of your diagnosis.

SURGICAL MARGIN EVALUATION
Oriented ellipse, unoriented ellipse, deep-shave or punch biopsy extending completely around lesion are all acceptable.

 

MELANOCYTIC LESION
Most preferable is an ellipse, followed by a punch biopsy and a deep-shave biopsy. Subungual lesions are best biopsied with punch technique. Curettings should be avoided.

 

KERATINOCYTIC LESION (BCC, SCC)
Most preferable is a shave biopsy.

 

SUSPECTED HEMATOPOETIC LESION
Most preferable is a punch biopsy. Important: Do not crush specimen—handle gently with forceps. Send entire punch biopsy for histologic analysis in formalin. Optionally, half may be sent in formalin for histologic analysis and half submitted rapidly fresh for possible flow cytometry. (Flow cytometry results are often poor when using skin; fresh, unfixed, rapidly submitted whole blood, bone marrow or lymph node tissue are better specimens for flow.)

 

BLISTERING DISORDERS/ADVANCED IMMUNODERMATOLOGY TESTING
Our Immunodermatology specialty laboratory offers comprehensive direct and indirect immunofluorescence, salt split skin and Western immunoblotting for specific autoimmune disease antibody subclass characterizations. Our GDA Immunodermatology requisition form is available for your ordering convenience. Please see our recommendations on specific biopsy techniques and specimen packaging and shipping for best patient care results.

 

SUSPECTED INFECTIOUS DISORDER
Most preferable is a deep punch biopsy, with adequate dermal tissue for analysis. Always bisect specimen and submit half for cultures.

 

SUSPECTED CONNECTIVE TISSUE DISORDER/COLLAGEN VASCULAR DISORDER
Most preferable is a punch biopsy of sun-exposed, lesional skin. Remember: Direct immunofluorescence studies may be negative in very new or very old clinical lesions.

 

SUSPECTED VASCULITIS
Most preferable is a punch biopsy from clinically new lesional skin.

 

SUSPECTED PANNICULITIS
Most preferable is a small ellipse excision extending to subcutaneous fat; second choice is a deep punch biopsy.

 

ALOPECIA
Most preferable is a 4mm punch biopsy from clinical rim of alopecia involvement.

 

SUSPECTED CONNECTIVE TISSUE NEVI
Most preferable is an ellipse, including both lesional and perilesional tissue.

Please do not hesitate to call us with any questions on biopsy techniques!