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January 2014

Biopsy Techniques: Shave, Punch, or Excision?

Author Affiliations
  • 1Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
JAMA Dermatol. 2014;150(1):12-13. doi:10.1001/jamadermatol.2013.7226

The Viewpoint by Sellheyer et al1 in this issue highlights a very important dilemma in both clinical dermatology and dermatopathology: what is the appropriate biopsy for a specific type of lesion, and what guidelines should be issued to assist the clinician in performing the appropriate biopsy for the suspected diagnosis?

The authors give examples of 2 shave biopsies, both for presumed keratinocytic malignant neoplasms. In the first, only a few of the step sections showed basaloid islands; in the second, only a diagnosis of an atypical squamous proliferation could be made because of an inadequate biopsy. Because of uncertain diagnoses, repeat biopsies are often necessary. The authors indicated that an initial procedure that balances aesthetic considerations with the appropriate tissue requirements for diagnosis should be the paramount concern.

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