9 tips to help prevent derm biopsy mistakes
The authors—with expertise in dermatology and pathology—provide pointers that can help you improve your approach to skin biopsy.
To properly record the site of a biopsy for future dermatologic exams, take pictures of the lesion at the time of biopsy. The photographs should clearly document the lesion in question, and should be taken far enough from the site that surrounding lesions and/ or other anatomic landmarks are also visible. Biangulation or triangulation (taking a series of 2 or 3 measurements, respectively, from the site of the lesion to nearby anatomic landmarks) can be used in conjunction with photographs.
When using measurements, be as specific and accurate as possible with anatomic terms. For example, measuring the distance from the “ear” is not helpful. It would be more helpful to measure the distance from the “tragus” or the “root of the helix.” Without a properly photographed and documented biopsy site, surgical treatment may need to be delayed until the location can be confirmed.
8. Give the pathologist a pertinent history.
Providing the pathologist with a sufficient history, including the distribution and appearance of the lesion, and how long the patient has had it, can be essential in narrowing the diagnosis or making the differential diagnoses. Things like medication use or new exposures to perfumes, lotions, or plants can be especially helpful and are often overlooked when filling out the pathology requisition form.
When warranted, phone calls are helpful. You might, for example, call the pathologist and give him or her a more detailed physical examination description or additional pertinent history that was discovered after the requisition was filled out. Providing a good history can make the difference between a specific diagnosis and a broad differential.
9. Know when to refer.
There is no shame in asking for a second opinion when it comes to evaluating a skin issue, especially in regards to melanocytic neoplasms, where the stakes can be high, or skin eruptions that do not respond to conventional therapy. Remember, many cases are difficult, even for experts, and require a careful balance of clinical and histopathological judgment.18
CORRESPONDENCE
Jayson Miedema, MD, Department of Dermatology, University of North Carolina at Chapel Hill, 410 Market Street, Suite 400, Chapel Hill, NC 27516; jmiedema@unch.unc.edu
