1. Common techniques Punch biopsy Superficial and deep shave biopsy
Deep incisional biopsy
Complete excision
Curettage

2. The choice of technique
Clinical differential diagnosis
Mental review of the pathology of each disorder
Anatomic site
Morphology of the lesion
Size and shape
Overall physical health of the patient
Cosmetic concerns

3. Appropriate lesion
A fully developed lesion is better than an early or involving lesion
Exceptions:
Vesicobullous lesions
Ulcers
Pustular lesions
For these a very early lesion

4. IDEAL CANDIDATE LESION
NOT SCRATCHED AND NOT TRAUMATIZED
UNTOUCHED BY TOPICAL OR SYSTEMIC THERAPY
FOR DIFFERENT STAGE OF EVOLUTION:
MULTIPLE BIOPSY

5. When considering diagnoses such as:
Connective tissue nevus
Anetoderma
Some pigmented disorseds , it is important to compare involved and uninvolved skin(biopsy with scalpel from lesion and adjacent normal skin

6. SCALP BIOPSY FOR ALOPECIA
Transverse or sectioning horrizental
Vertical sectioning
punch biopsy for scalp
Should be inserted parallel to the direction of hair growth
Well into subcutis
In scaring alopecia: an area of erythema with visible hair shafts

7. Punch biopsy
Standard for inflammatory dermatoses
Often used for neoplasm
4mm is adequate
3mm for small lesions or for face or cosmetic
6mm if paniculitis is suspected(or deep incidional biopsy)
Notice:
After loosening of the skin should be handled very gently
Lymphoma and leukemic particularly suseptible to crush
For inflammatory disease shoud extend to subcutaneous fat

8. Shave biopsy Superficial Deep
Superficial shave biopsy used for lesions with histologic changes in epiderm or superficial dermis such as:
SK,AK,wart,benign nevus,BCC
Cosmesis: is often improved

9. Saucerization technique:at roughly a 45 degree blade is introduced
Inadequate for differentiating between SCC & keratoacanthoma
Contraindicated if melanoma is included
In acral skin:may produce a superficial specimen
punch biopsy or smalll excision is best method in acral pigmented lesion
Hemostasis: aluminum chloride
Alternatives for hemostases:monsel” solutions,electrocautery(may affect on interpretation subsequent biopsy)

10. Deep incisional biopsy
Indications:
Panniculitis
deep dermal or subcutaneous nodules
Complete excision:
atypical pigmented lesions
evaluation of margins

11. curattage The least satisfactory
Submitted material:scanty & superficial,may show crush artifact
Curettage of a melanoma resembles a seborrheic keratosis or pigmented BCC

12. Biopsy specimen Should be placed in fixative immediately
Should not be allowed to dry
Should dermatologist check the specimen bottle
Should patient information be placed on the bottle itself
FIXATIVE: 10% BUFFERED FORMALIN
In winter for prevention of formation of ice crystals:
Add 95% ethyl alcohol ,10% by volum Or
Specimen in formalin at room temperature for at least 6 hours befor mailing

13. Detaile clinical information
Diferential diagnosis
Available clinical information
Previous biopsies
Specific requests
Special stains for infection
Stain for lipids:specimen must not be processed in automatic processor