the skin biopsy. in no other field of medicine is tissue for histologic examination so easily...
TRANSCRIPT
![Page 1: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/1.jpg)
The Skin Biopsy
![Page 2: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/2.jpg)
• In no other field of medicine is tissue for histologic examination so easily accessible.
• As a result, the skin biopsy has become an integralcomponent of dermatologic diagnoses
![Page 3: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/3.jpg)
Skin biopsies are performed for a multitude of reasons, including:
• uncertainty about the clinical diagnosis• to investigate a poor response to therapy• to exclude or investigate the evolution of one
condition into another• to investigate symptoms in the absence of
clinically recognizable disease.
![Page 4: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/4.jpg)
• the process of securing appropriate tissue involves more than the mere mechanical removal of a specimen
![Page 5: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/5.jpg)
Pitfalls of Skin Biopsy:
![Page 6: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/6.jpg)
Site Selection:
• First step : Identify an unadulterated primary lesion (Exclude lesions with secondary changes)
• Second Step: choose Well developed but Fresh Lesion (It show the most characteristic and diagnostic histopathology ( Except : LCV)
![Page 7: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/7.jpg)
![Page 8: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/8.jpg)
Site Selection:
• 3rd Step: Obtain from central aspect of a primary lesion (except ulcer or subtle change as anetoderma)
• 4th Step: selection of a proper biopsy site mayalso be influenced by knowledge of the
underlying pathology and pathophysiology of the most likely diagnoses.
![Page 9: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/9.jpg)
Biopsy techniques:
• Superficial (tangential shave)• deep shave (saucerization)• punch • incisional/excisional
![Page 10: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/10.jpg)
![Page 11: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/11.jpg)
the technique: 1-must obtain tissue from the level of the skin
or subcutaneous tissue where the pathologic changes are expected
2- simultaneously balancing concerns of cosmesis and morbidity.
![Page 12: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/12.jpg)
• Panniculitis: Do not perform shave biopsy
• Verruca or Skin Tag: Do not perform Excision
![Page 13: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/13.jpg)
![Page 14: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/14.jpg)
Curettage
• a curette 3-5 mm in diameter is held like a pencil and drawn with pressure under the
lesion (if epidermal) or through the lesion (e.g. presumed BCC).
• This type of biopsy assumes that healing will be by second intention.
• The resulting scar is usually minimal
![Page 15: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/15.jpg)
![Page 16: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/16.jpg)
![Page 17: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/17.jpg)
Shave Biopsy:
• Perform when:1-the pathologic process is primarily
epidermal2- when removing exophytic benign
lesions
• E.g. intradermal melanocytic nevi or pigmented actinic keratosis or Bowen's disease versus macular
seborrheic keratosis)
![Page 18: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/18.jpg)
![Page 19: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/19.jpg)
Deep shave/saucerization biopsy
• Deeper variant of the superficial shave biopsy
• Often used to biopsy neoplasms (e.g. SCC versus hypertrophic AK)
when properly performed, its diagnostic value is nearly equal to most incisional/excisional procedures
![Page 20: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/20.jpg)
![Page 21: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/21.jpg)
Punch biopsy:
• Perform when suspected pathology is within the dermis
and • when a partial sampling will be
representative of the entire lesion or process.
![Page 22: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/22.jpg)
Punch Biopsy:
• Poor Results:• assessment of deeply
infiltrating tumors or the full thickness of the subcutaneous fat.
• Partial punch biopsies of melanocytic neoplasms can lead to erroneous diagnoses.
![Page 23: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/23.jpg)
![Page 24: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/24.jpg)
![Page 25: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/25.jpg)
![Page 26: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/26.jpg)
Incisional /excisionalbiopsy• Incisional: removal of a
portion of a lesion (e.g. Panniculitis)
• Excisional: Removal of the entire lesion via a scalpel and
standard surgical techniques(e.g. Melanoma)
![Page 27: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/27.jpg)
![Page 28: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/28.jpg)
![Page 29: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/29.jpg)
![Page 30: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/30.jpg)
![Page 31: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/31.jpg)
![Page 32: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/32.jpg)
![Page 33: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/33.jpg)
Post-procedure handling of the biopsy
• Avoid crush artifact especially for small punch biopsy.
• Lymphocytes are particularly susceptible to crush artifact, and when present, it may be impossible to render an accurate diagnosis.
![Page 34: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/34.jpg)
• For routine histologic exam: place the specimen in the formalin container (volume 10x to 20x)
• Microbial culture: place in the non-bacteriostatic saline container and deliver immediately to LAB.
• For DIF: Flash Frozen or use Michel Solution
![Page 35: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/35.jpg)
Other Information:
• Age and sex of the patient
• Anatomic site• Pertinent and precise
physical findings• Differential diagnosis• Treatments• Drawings or clinical
photographs
![Page 36: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/36.jpg)
![Page 37: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/37.jpg)
![Page 38: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/38.jpg)
![Page 39: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/39.jpg)
![Page 40: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/40.jpg)
![Page 41: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/41.jpg)
![Page 42: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/42.jpg)
![Page 43: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/43.jpg)
![Page 44: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/44.jpg)
![Page 45: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/45.jpg)
![Page 46: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/46.jpg)
![Page 47: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/47.jpg)
![Page 48: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/48.jpg)
![Page 49: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/49.jpg)
![Page 50: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/50.jpg)
![Page 51: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/51.jpg)
![Page 52: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/52.jpg)
![Page 53: The Skin Biopsy. In no other field of medicine is tissue for histologic examination so easily accessible. As a result, the skin biopsy has become an integralcomponent](https://reader036.vdocument.in/reader036/viewer/2022081519/56649cbf5503460f94985436/html5/thumbnails/53.jpg)