Skin biopsy: when is it indicated and which techniques to use?

Indications:

Suspected neoplasia.
Nodules, ulcers or wounds that do not heal.
Vesicular or pustular lesions (after infections have been ruled out and/or treated).
Severe skin lesions that appear suddenly.
Suspected dermopathies that will require expensive, potentially dangerous (e.g. immunosuppressive) and long-term treatment.
When there has been no response to treatment, or when new lesions appear during treatment.
When the presentation suggests a disorder that is diagnosed by histopathology.

 

Techniques and indications:

TechniqueIndications
Punch– Primary lesions that can be included in their entirety in biopsy
– Alopecia (important to sample several areas, including the centre of the alopecia, the margin and areas of normal skin)
Incisional/excisional– Fragile lesions (e.g. vesicles) that could rupture with the use of a punch.
– Deep, ulcerated lesions where the biopsy must go deep into the subcutaneous tissue
– Ulcerated lesions where the biopsy should contain a portion of normal skin

 

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