1. Make one large excisional biopsy or two separate 4 mm punch biopsies from active portion of the alopecia patch.
2. Please write on the requisition form “follow Alopecia protocol” along with any pertinent clinical history.
An accurate diagnosis requires a deep skin biopsy to or past the fascia to include mutiple fat lobules. Make an excisional biopsy deep to subcutaneous fat/fascia if the dermis is thick.Â A 6 mm punch biopsy could also be performed if the dermis is thin.Â If performing a punch please be sure to capture as much subcutaneous fat as possible by pulling up the punch biopsy gently and cutting it off as deep as possible.
Please provide a 4 mm punch biopsy from de-pigmented area and a 4 mm punch biopsy from normal skin in a separate container for comparision. On the requisition form please be sure to provide information of patients race so normal skin pigmentation can be determined.
Suspected Melanoma/Atypical Moles
In most cases an excisional biopsy that includes the entire lesion is preferred.Â Â In cases where the lesion is small or in a cosmetically sensitive spot then a deep shave biopsy can be used provided that the entire lesion is removed.
Performing superficial shaves on suspected melanoma cases may result in limited diagnostic and prognostic interpretation.
Suspected Bullous Diseases
1. Use a punch biopsy and include the edge of the blister.
2. Collect specimen for direct immunoflourescence (DIF) in Mitchel’s media in separate container.
3. Be sure to provide clinical history and write on the requisition that both H&E and DIF are needed.
General Specimen Collection Tips
1. Minimize use of electric cautery while taking the biopsy. After biopsy has been collected cautery can be used as needed.
2. For small, hard to catch specimens minimize forcep use/pressure while handling the specimen. Most of the time specimen can be easily floated off the blade directly in to the formalin container.
3.Â Minimize use of any chemical hemostatic agent before and during the biopsy collection.Â Once biopsy is collected/completed, use chemical hemostat on an as needed basis.
4.Â Please provide your differential diagnosis and description of the lesion/rash on requisition to avoid any delays/back and forth phone calls.
5. If a suture is attached with the specimen, please be sure to indicate suture position for accurate specimen orientation and margin’s reportation.