Biopsy Selection: Pearls and Pitfalls
About this video
Where, when, and how a biopsy is taken can determine how much the specimen is able to reveal. In this case-based presentation, John R. Griffin, MD, MA, FAAD, walks through the practical decisions that shape biopsy yield, including choosing the appropriate technique, targeting the most informative area of a lesion, and using the correct transport medium. He applies those principles across common but easily mishandled scenarios, from selecting fresh lesional skin in suspected small-vessel vasculitis and obtaining the right specimen for direct immunofluorescence in blistering disease to distinguishing biopsy approaches for scarring, nonscarring, and patchy alopecia. Along the way, he highlights the seemingly small choices that can introduce artifact, miss the active disease process, or leave the pathologist without the tissue needed to answer the clinical question.
Question: A patient has suspected scarring alopecia with a smooth center and perifollicular erythema at the margin. Which biopsy approach is most likely to yield a diagnosis?
Rationale: The fully scarred center may show only end-stage change. Sampling the active margin, where follicles remain, is more likely to capture the underlying inflammatory process.