Common techniques 1 Punch biopsy 2 Superficial and

Common techniques 1) Punch biopsy 2) Superficial and deep shave biopsy 3) Deep incisional biopsy 4) Complete excision 5) Curettage

The choice of technique 1. 2. 3. 4. 5. 6. 7. Clinical differential diagnosis Mental review of the pathology of each disorder Anatomic site Morphology of the lesion Size and shape Overall physical health of the patient Cosmetic concerns

Appropriate lesion A fully developed lesion is better than an early or involving lesion Exceptions: 1. Vesicobullous lesions 2. Ulcers 3. Pustular lesions For these a very early lesion

IDEAL CANDIDATE LESION NOT SCRATCHED AND NOT TRAUMATIZED 2. UNTOUCHED BY TOPICAL OR SYSTEMIC THERAPY 1. 3. FOR DIFFERENT STAGE OF EVOLUTION: MULTIPLE BIOPSY

�When considering diagnoses such as: �Connective tissue nevus �Anetoderma �Some pigmented disorseds , it is important to compare involved and uninvolved skin(biopsy with scalpel from lesion and adjacent normal skin

SCALP BIOPSY FOR ALOPECIA Transverse or sectioning horrizental 2. Vertical sectioning 1. punch biopsy for scalp �Should be inserted parallel to the direction of hair growth �Well into subcutis �In scaring alopecia: an area of erythema with visible hair shafts

Punch biopsy v Standard for inflammatory dermatoses v Often used for neoplasm v 4 mm is adequate v 3 mm for small lesions or face or cosmetic v 6 mm if paniculitis is suspected(or deep incidional biopsy) Notice: q After loosening of the skin should be handled very gently q Lymphoma and leukemic particularly suseptible to crush q For inflammatory disease shoud extend to subcutaneous fat

Shave biopsy A. Superficial B. Deep C. Superficial shave biopsy used for lesions with histologic changes in epiderm or superficial dermis such as: D. SK, AK, wart, benign nevus, BCC v Cosmesis: is often improved

v Saucerization technique: at roughly a 45 degree blade is introduced v Inadequate for differentiating between SCC & keratoacanthoma v Contraindicated if melanoma is included v In acral skin: may produce a superficial specimen v punch biopsy or smalll excision is best method in acral pigmented lesion v Hemostasis: aluminum chloride v Alternatives for hemostases: monsel” solutions, electrocautery(may affect on interpretation subsequent biopsy)

Deep incisional biopsy �Indications: Panniculitis 2. deep dermal or subcutaneous nodules 1. �Complete excision: 1. atypical pigmented lesions 2. evaluation of margins

curattage v The least satisfactory v Submitted material: scanty & superficial, may show crush artifact v Curettage of a melanoma resembles a seborrheic keratosis or pigmented BCC

Biopsy specimen v Should be placed in fixative immediately v Should not be allowed to dry v Should dermatologist check the specimen bottle v Should patient information be placed on the bottle itself FIXATIVE: 10% BUFFERED FORMALIN In winter for prevention of formation of ice crystals: Add 95% ethyl alcohol , 10% by volum Or Specimen in formalin at room temperature for at least 6 hours befor mailing

Detaile clinical information v Diferential diagnosis v Available clinical information v Previous biopsies Specific requests v Special stains for infection v Stain for lipids: specimen must not be processed in automatic processor