Dermatologists are frequently consulted to assist in the diagnosis of calciphylaxis, which requires the identification of representative histopathologic features in the appropriate clinical setting.1 Currently used biopsy techniques (punch and incisional wedge) are high-risk procedures with a combined diagnostic yield as low as 18%.2-4 The need for an alternative diagnostic approach is clear, with a minimally invasive technique capable of selectively obtaining representative tissue being ideal. Recent experience leads us to recommend the use of an image-guided core-needle biopsy in the diagnostic evaluation of cutaneous calciphylaxis.