Download - Guide on skin biopsy. Mikhail Valivach
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Guide on skin biopsy in inflammatory cutaneous diseases
Mikhail Valivach, MD,Head of cytomorphology division.
Pavlodar Regional Diagnostic Center2015
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• Punch biopsy is performed using a circular blade attached to a pencil-like handle.
• Punch diameters can be from 2 to 6 mm.
• Four mm punches are appropriate in most cases of skin biopsy.
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Punch
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Choice of appropriate time• Many of skin lesions have rapid dynamics.• It is supposed that during first 18 hours since
lesion onset inflammatory changes have not fully developed already.
• Changes reach maximum in 24-36 hours.• In 48-72 hours primary inflammatory infiltrate
can dramatically change (for example, lymphocytes and histiocytes can come instead of neutrophils), and deposited immune complexes can be destroyed by complement.
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Choice of appropriate time
• The age of 24-36 hours is optimal for biopsy of inflammatoty lesions!!!
• If this is not possible, then pathologist should choose the most appropriate lesion.
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Selection of biopsy area
• Bullous lesions
• Biopsy of the edge of lesion. Even better to make biopsy of erythema before development of bulla.
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Selection of biopsy areaBullous lesions
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Selection of biopsy areaBullous lesions
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Selection of biopsy areaBullous lesions
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Selection of biopsy areaDermatitis herpetiformis
• Normally looking skin in 3 mm from a vesicle.
• Better to make 2-3 biopsies.
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Selection of biopsy areaDermatitis herpetiformis
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Selection of biopsy areaDermatitis herpetiformis
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Selection of biopsy areaDermatitis herpetiformis
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Selection of biopsy areaPorphyria and pseudoporphiria
• The edge of a fresh vesicle (bulla).
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Selection of biopsy areaPorphyria and pseudoporphyria
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Selection of biopsy areaPorphyria and pseudoporphyria
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Selection of biopsy areaPorphyria and pseudoporphyria
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Selection of biopsy areaSuspected lupus erythematosus or
dermatomyositis• Edge of an erythematous lesion. Fresh
elements are preferable. • It is better to take additionally normally
looking skin. • If you want to reveal “lupus band”, you can
expose skin to suberythematous dose of ultraviolet and perform biopsy in 24 hours.
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Selection of biopsy areaSuspected lupus erythematosus
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Selection of biopsy areaSuspected lupus erythematosus
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Selection of biopsy areaSuspected lupus erythematosus
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Selection of biopsy areaSuspected lupus erythematosus
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Selection of biopsy areaSuspected dermatomyositis
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Selection of biopsy areaSuspected dermatomyositis
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Selection of biopsy areaSuspected dermatomyositis
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Selection of biopsy areaSuspected vasculitis
• Biopsy of a fresh element aged from 16 to 32 hours.
• It is better to take additionally normally looking skin.
• Selection of biopsy area has a critical significance for subsequent histological and immunofluorescent tests. It is better to select the area together with pathologist.
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Selection of biopsy areaSuspected vasculitis
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Selection of biopsy areaSuspected vasculitis
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Selection of biopsy areaSuspected vasculitis
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• We also recommend you to read the article Punch Biopsy of the Skin. THOMAS J. ZUBER, M.D. Am Fam Physician. 2002 Mar 15;65(6):1155-1158.
• The article is available online http://www.aafp.org/afp/2002/0315/p1155.html
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• Video on punch biopsy technique is available in youtube.com use key words the punch biopsy dermeducation
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• Dear colleagues, with questions and suggestions you can address to Mikhail Valivach [email protected]
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• Thank you for your attention!