The submission of a skin biopsy for histopathological examination may be a request for a specialist medical opinion. In a general practice setting, this means for the GP to request the support of a Specialist Pathologist to examine a sample that has been biopsied or excised from a patient. Clinical information including the details of the presenting complaints, previous medical history, and a full list of medication is appropriate to be included in histopathology referrals.
Timing and Siting of the Biopsy Technique
In most cases, it is best to avoid the biopsy of lesions that demonstrate obvious secondary changes. Lesions with active inflammatory processes and those which are intensely itchy skin, it is best to biopsy at an early stage. Similarly, blistering diseases necessitate that attention is given to newly formed or evolving blisters, rather than areas of erosion or areas where the lesion has broken down.
Conversely, in some cases, it is best to biopsy an established lesion when early lesions may not show specific diagnostic features, such as in the case of a scaly plaque or plaque psoriasis or a longstanding active lesion of cutaneous lupus erythematosus. Any lesions showing signs of chronic fibrosis processes should also be biopsied at a late stage.
Prior Treatment of Biopsy Technique
Topical steroid treatments can alter the histological appearances of many lesions significantly. Where possible, it is important to biopsy areas that are untreated by the topical treatments are that have been left untreated for a period of 4 weeks prior to the biopsy.
When sampling the advancing fringe of a lesion, significant amounts of normal tissue shouldn’t be taken at the expense of lesion material.
The less invasive biopsy techniques, shave biopsy or punch biopsy, are less likely to adequately sample deeper tissues, and are thus inappropriate for conditions where the pathological changes are located in deeper areas.
Summary of Biopsy Procedure
1. Prove Appropriate Clinical Information
a.Description of the lesion(s)
b.Clinical differential diagnosis
2. Medical history
- Select Appropriate Lesion
- Pruritic, blistering: EARLY
- Vasculitis: MID
3. Psoriasis, lupus, fibrosing: LATE
- Avoid lesions which have been treated
4.Select the Area to Biopsy
- For most circumstances choose the advancing fringe of the lesion
- Lesional tissue is more suitable than non-lesional tissue
5.Select the Appropriate Biopsy Technique
- Shave Biopsy
- Punch Biopsy
- The anatomical area of the likely pathology
- Consider cosmetic outcome
7.Material for Ancillary Testing is Required
- Blistering, lupus, vasculitis: Direct immune Florescence
- Infection: Microbiology
Lymphoma: Contact Best Dermatologist In Coimbatore
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