1. Skin Biopsy Technique for Cutaneous Nerve Evaluation
Johns Hopkins University
Department of Neurology
Skin Biopsy Technique for Cutaneous Nerve Evaluation
Biogen Idec 103NS201
Neublastin Trial

2. Why Skin?

3. Johns Hopkins Cutaneous Nerve Laboratory
•      First CLIA / JCAHO / CAP certified clinical lab for epidermal quantitation – 35,000+ biopsies processed
•      Validated direct measure of axonal integrity
•     Demonstrated that epidermal nerve fibers are lost early in PN disease
•         Therefore often more sensitive than nerve conduction
•          IGT (pre-diabetes), HIV infection, amyloid, idiopathic neuropathy, CIPN
•     Core Laboratory for over one dozen multicenter clinical trials
•     Developed efficient models of nerve regeneration using injury models
•      Efficient safety measure of potential toxicity

4. The following items will be supplied by the central laboratory for the skin punch biopsies:
• Sterile disposable 3mm skin punch
• Sterile disposable forceps
• Sterile disposable scalpel
• Zamboni’s fixative solution (individual pre-filled tubes)
• Phosphate buffer (individual pre-filled tubes)
• Cryoprotective solution (individual pre-filled tubes)
• Sample vials
• Requisition form
• Parafilm (for securely sealing the sample vial)
• Template for biopsy site locations (1 per subject)
• Easy to follow reference sheet
• Cooler shipping box and ice pack

5. Skin biopsy template

8. Skin biopsy gets a bad wrap…

9. This will only hurt a little…

10. Biopsy Supplies

13. Use of countertraction and single slice to obtain biopsy

14. Biopsy Precautions
Check with patient regarding allergies to lidocaine or adhesives
Do not biopsy distal to, or on surgical site or scar tissue
Do not stretch skin while performing punch biopsy
Do not grasp across the entire superficial dermis or any epidermis
Do not allow tissue to dry out at any time, place in fix immediately
Fix for 6-24 hrs in refrigerator-do not freeze!
Do not crush biopsy while screwing on tube cap
Carefully fill out all associated paperwork, double checking tube
labels and biopsy requisition forms!

16. PGP9.5 Immunohistochemistry
Stratum corneum
Sensory
nerves
Epidermis
Dermis
PGP9.5 Immunohistochemistry

18. All centers should evaluate their biopsies at the time of biopsy…

20. Crush artifact caused by forceps during biopsy

23. Do NOT place biopsies in dry tubes without fix!

24. Twist punch tool away from seam edge…

26. Busy lab needs your help with QC of specimens…

27. Details…