Skin nontumor



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PubMed Search: Grossing

Cecilia Rosales, M.D.
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Table of Contents
Biopsy | Grossing
Cite this page: Rosales C. Grossing. website. Accessed September 27th, 2023.
  • If possible, biopsy a primary lesion
  • Proper selection of anatomical site and best lesion to perform a biopsy are very important (An Bras Dermatol 2009;84:507)
  • Biopsy characteristic areas in their diagnostic stage, not ruptured bullae, secondarily infected / scratched areas or involuting lesions
  • Some lesions are best diagnosed early (blisters, vasculitis) or late (psoriasis, discoid lupus erythematosus, lichen planus)
  • Punch biopsy of nearby normal skin may be helpful, particularly if changes in abnormal areas are quantitative (hyperkeratosis, acanthosis, etc.)
  • Must recognize that biopsy captures histopathology only at one point in time in evolution of a lesion
  • For inflammatory lesions, biopsy should correlate with clinical differential diagnosis
  • For widespread dermatoses, avoid biopsying lesions on the legs; at this site but not elsewhere, the biopsy heals slowly and lesions are often hemorrhagic
  • For alopecias, biopsy the border of active lesions but if evaluation for hair regrowth is needed, biopsy the most advanced area
  • For metabolic abnormalities, electron microscopy of axillary skin biopsy may be helpful, although results may be nonspecific (Hum Pathol 2001;32:649)
  • Breadloafing (serial section) of ellipses is often best cut perpendicular to long axis at 3 mm intervals
  • Always ink margins for tumors, including deep margin
  • Bisect punch biopsies if 4 mm or larger

  • Biopsy for alopecia: can be cut perpendicular or horizontal depending of the pathology

  • Tzanck preparation (smear):
    • Used to identify Tzanck (multinucleated) cells of herpes simplex, Varicella and herpes zoster, pemphigus vulgaris or cytomegalovirus
    • Scrape the base of the blister / ulcer with the round base of the scalpel
    • Smear on a glass slide
    • Air-dry and stain with Wright's or Giemsa stains

  • Scabies (scrapping):
    • Place a drop of immersion oil on a microscope slide
    • Place a drop of immersion oil on the scalpel
    • Scrape the stratum corneum off the surface of the lesion
    • Numerous lesions should be scraped and placed on the same microscope slide

  • Submit fresh tissue for:
    • Immunofluorescence (can also use Michels medium)
    • Bacterial, fungal, and viral cultures
    • Chromosomal analysis
    • Antigen mapping of basement membrane zone / BMZ (saline splitting)
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