Skin biopsy – the most important diagnostic procedure in the field of dermatology. It is a skin biopsy that in many cases is the method of final verification of the diagnosis. In addition, biopsy plays a key role in determining the management of cancer patients.
Carrying out a skin biopsy requires high qualification and professionalism from the doctor. For more information about the indications for skin biopsy, as well as the practical aspects of the manipulation: tools, technique features, read on estet-portal.com in this article.
Skin biopsy should be performed if the nature of the lesion is questionable
After a skin biopsy, all materials removed from the body must be sent for pathological examination. Seborrheic keratosis and typical epidermoid cysts (containing a light keratin mass) in most cases do not require morphological examination.
If a dermatological lesion is in doubt, a biopsy should be performed.
Malignant skin tumors are rare in children.
For more information on what are the indications for a biopsy procedure, read further in the article.
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What are the indications for skin biopsy
In addition to determining the nature of the neoplasm, a skin biopsy can also be used to verify other pathological conditions. These include discoid lupus erythematosus, as well as pathologies where harmless-looking dermatological formations do not respond to standard treatment.
In some cases, it is necessary to conduct a differential diagnosis with oncological formations. For example, an eczematous chronic rash may be cutaneous lymphoma or subcutaneous carcinoma, but biopsy is necessary to verify these.
Psoriasis is usually diagnosed clinically in most cases and the need for a biopsy is rare.
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In a chronic skin disease (eg, pemphigoid), there is also a need for an immunofluorescent test (IF). The sample must contain a formalin-fixed blister and a small, fresh, periletic skin sample for IF testing.
If transport in liquid nitrogen is not available, a fresh tissue sample can be sent in a transportable medium (Michelin fixative) which will keep it for 5 days.
Skin biopsy technique: instruments, sampling
Scalpel (#15) is used for skin biopsy. An incision is made through the skin down to the subcutaneous fat layer. The biopsy should be in the shape of a boat with a flat bottom. The location for the biopsy should be chosen so that no formations limit the depth of the study. The incision should be made in the direction of the skin folds to minimize scarring. The standard size for a biopsy specimen is 0.5 x 1.5 cm with thickness depending on the site.
Puncture biopsy (usually 3-6 mm) is most suitable for diagnosing isolated tumors.
Puncture biopsy may be required in several locations to examine the morphological elements of the rash and larger lesions.
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It is important to emphasize that, according to international recommendations, a needle biopsy of the skin can be performed even in cases where the nature of the neoplasm is presumably malignant.
The punch biopsy specimen must contain a layer of subcutaneous fat. The biopsy site is usually not sutured. In case of bleeding, a small bandage may be used.
The biopsy specimen must not be compressed or torn. The tools that are used to process the skin biopsy sample include small forceps, a hook, and a needle.
Determination of healthy tissue stock during skin biopsy
You should avoid taking a biopsy in areas of the skin where there are scratches. In case of undulating dermatological diseases, as well as in vasculitis, the best place for biopsy is the areas of fresh rashes.
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Material is always taken from the central affected area. The only exception is a rash with a well-defined border. In these cases, the skin biopsy should be performed in such a way that the border is in the center of the sample.
Small blisters should be taken whole for examination. Needle biopsy is not an appropriate method, as the blister cover may prevent further diagnosis.
Small tumors should be taken for examination in their entirety. A 1-2 mm supply of healthy tissue is sufficient along the edges of the cutout. A margin larger, 3-5 mm, may be needed if malignancy is suspected.
Puncture biopsy is a good alternative if further surgery is expected in any case. Areas with suspicious pigmentation changes should be completely removed, while the margin of healthy tissue is 1-2 mm.
If there is a discrepancy between the histopathological diagnosis and clinical manifestations, a second biopsy may be necessary.
Thank you for staying with estet-portal.com. Read other interesting articles in the "Dermatology" section. You might also be interested in: A multilevel program for the successful treatment of hyperpigmentation
Based on EBM Guidelines «Skin biopsy».
Adapted from EBM Guidelines "Skin biopsy"
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