Calciphylaxis, most commonly diagnosed in patients with endstage renal disease (ESRD) but also affecting patients with normal renal function, is a devastating disease characterized by the development of ischemic skin lesions and associated with substantial patient morbidity and high 1-year mortality rates. 1 Calciphylaxis was thought to be a rare disease; however, in recent years, reports and publications on the topic have increased. 2 Whether this increase is due to a rise in incidence or improved recognition is unclear. Calciphylaxis is primarily a clinical diagnosis, made by the presence of livedoid skin changes or retiform ulcers, often with a thick eschar, overlying painful indurated subcutaneous plaques located predominantly in adipose-rich areas in patients with risk factors such as chronic kidney disease, obesity, long-term warfarin exposure, autoimmune disease, long-term corticosteroid use, hypercoagulable states, liver disease, and other comorbidities. Formal diagnosis has traditionally necessitated a skin biopsy; however, whether histologic confirmation is needed for typical cases has been debated, because the procedure could predispose the patient to significant morbidity, including inducing an ulcer, poor wound healing, and subsequent infection, and trigger worsening of the thrombotic component of the disease. Avoidance of ulceration is important because ulcers are associated with higher mortality. 1 To expand the arsenal of diagnostic tools available to physicians for diagnosing calciphylaxis and to minimize risks to the patient, in this issue of JAMA Dermatology, Mask-Bull et al 3 describe a case of suspected calciphylaxis on the thigh that was diagnosed using ultrasonographic-guided percutaneous coreneedle biopsy. Multiple specimens of adipose were obtained using a 14-gauge needle under local anesthesia. Histopathologic evaluation demonstrated multiple foci of thrombosis, mixed inflammation, and mural calcification. Together with the clinical picture, these histopathologic findings support a diagnosis of calciphylaxis. The authors 3 argue that this procedure is less invasive and may carry a lower risk of complication while providing a greater volume of the target tissue (ie, adipose tissue) to pathologists. Radiographic guidance may also help to avoid false-negative findings where intermittent pathologic features within the vessels may be missed by standard biopsy. This report is to be taken with some caution, because some experts believe that calciphylaxis can koebnerize after mild skin trauma, including subcutaneous insulin and