Punch biopsies/punch excisions

Pathology of challenging melanocytic neoplasms. Diagnosis and Management. Christopher R. Shea, Jon A. Reed, Victor G. Prieto (Editors). Springer (2015)

Punch biopsies of skin produce a cylindrical portion of tissue that is oriented perpendicular to the epidermal surface. Punch biopsies often are performed to diagnose inflammatory dermatoses because they allow histological examination of epidermis, superficial and deep dermis, and possibly superficial subcutaneous adipose tissue. Similarly, a punch biopsy may be used for a melanocytic lesion that is suspected of having a deeper dermal or subcutaneous component. Larger punches also may used to completely remove a lesion that was previously biopsied by a smaller diameter punch biopsy or by a superficial shave biopsy (see below).

Small punch biopsies should be used with caution when sampling a melanocytic neoplasm [5].

A single small punch biopsy may yield a nonrepresentative sample form a large atypical melanocytic neoplasm. Multiple smaller punches may be used; however, to “map” peripheral spread of a large lesion such as lentigo maligna that has previously been diagnosed by another biopsy.

Handling of a punch biopsy is straightforward. Punches intended to completely remove a lesion should be marked with indelible ink along the entire dermal surface including periphery and base, sparing only the epidermal surface. Specimens larger than 3 mm in diameter are bisected, and very large specimens, serially sectioned along the long axis (i.e., perpendicular to the epidermal surface). After routine tissue processing, histological sections cut perpendicular to the epidermis will thus have a perimeter marked by ink that defines the surgical margin (Fig. 1.1).

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