Improving diagnostic yield of punch biopsies of the skin

Maximizing diagnostic outcomes of skin biopsy specimens

“…In addition, establishing which part of the lesion to biopsy is just as important as choosing the appropriate lesion. Most inflammatory conditions give the highest yields at the lesion's center, which represents the focus of maximal induration or elevation . By contrast, autoimmune blistering disorders, biopsies of which require additional immunofluorescent techniques, should be subject to perilesional skin sampling for accurate diagnosis .…”

“…By contrast, specimens of cutaneous lupus erythematosus, cutaneous vasculitis, and blistering disorders, such as porphyria, should be taken from the lesional areas themselves. Annular lesions, such as granuloma annulare, should be sampled from the active advancing edge to achieve the best diagnostic results …”

“…The lower extremities have also been reported to show the lowest incidence of positive immunofluorescent findings in several diseases, including bullous pemphigoid . In addition, biopsies should not generally be taken from bony prominences because these sites commonly show nonspecific lymphocytic infiltrates and display epidermal hyperplasia …”

“…The punch biopsy may not be the best modality for diagnosing nail pathologies, but it remains a practical and efficient tool, especially when diseases of the nail plate are under consideration. This is not the case for pathologies of the nail matrix and nail bed, which require a large punch to remove the nail plate, in addition to a smaller punch to sample the nail bed or matrix …”

“…Once the biopsy has been fixed in its appropriate medium, the next step in the biopsy process refers to laboratory handling of the specimen. This includes grossing, processing, embedding, and staining . The area to be inked is dictated by the nature of the biopsy.…”