It’s frustrating for you and your clients if a skin biopsy result comes back non-diagnostic. Here are some of the things I do to get the most information that I can from dermatopathology.
1. For inflammatory skin diseases, do not do a surgical scrub or remove crusts at the site. You can clip the hair short, if there is any in the area, but try not to alter the skin surface. Valuable information will be thrown in the trash if you do!
2. Select a range of lesions if there is an obvious progression evident. If there are papules, pustules, and crusts, take samples of each. Most pathologists will charge the same if you send in multiple samples from the same disease process.
3. Rotate the biopsy punch in one direction to minimize shearing artifact. This is especially important for delicate vesicles and pustules.
4. Find a good dermatopathologist. A pathologist with a special interest in skin is more likely to give your unusual skin biopsies that extra attention that can make all the difference.
5. Once you’ve found a dermatopathologist, help them out! The goal should not be to withhold a good history and your differential diagnosis in hopes that they will reach an unbiased conclusion. Providing them with a history and accurate lesion descriptions are crucial to getting the most useful information back.
Even with these precautions, there is a chance that you won’t be able to give the client a definitive diagnosis, so it’s best to set realistic expectations, as in “even if it is not 100% definitive, it will likely point us in the right direction.”