Why Have A Skin Biopsy?

Many people think of a dermatologist as someone who treats acne and warts, while some equate a dermatologist with the diagnosis and treatment of skin cancer. For others, the specialty of dermatology encompasses hair transplants, liposuction, facial peels, laser treatments and other cosmetic procedures. The truth, of course, is that dermatology is all of that and far more.

The skin, our largest organ, is truly a window through which a vast array of cutaneous, systemic, infectious and even genetic conditions can be viewed. While the vast majority of these conditions can be diagnosed, often at a glance, by a dermatologist, some require a skin biopsy to confirm a diagnosis or reveal an abnormality that may not have been suspected.

Skin cancer is, unfortunately, relatively common. Malignant melanoma is the most serious form of skin cancer and a skin biopsy is required for diagnosis. Many other conditions, both benign and malignant, may closely mimic a melanoma to the naked eye. Examples include benign nevi (moles), dysplastic nevi, seborrheic keratoses, pigmented basal cell carcinomas, squamous cell carcinomas and even pyogenic granulomas. Fortunately, melanoma is not the most common form of skin cancer. Basal cell carcinoma, squamous cell carcinoma and non-invasive (superficial) forms of squamous cell carcinoma such as Bowen’s disease (squamous cell carcinoma in-situ) and actinic (solar) keratoses are far more common. While many of these less serious forms of skin cancer are clinically obvious, most still require a skin biopsy for confirmation.

Skin cancer does not, however, begin and end in the skin. Virtually any systemic malignancy, including breast cancer, lung cancer, colon cancer, lymphoma and leukemia may spread to the skin. A skin nodule may even be the first sign of a systemic malignancy. Dermatologists and dermatopathologists are well aware that the appearance of a skin lesion in a patient with a known systemic cancer usually requires a biopsy to exclude a metastasis.

In nearly all areas of medicine it is easy to find conditions where a skin examination and biopsy may yield vital information. Does your child have a rash? Eczema (atopic dermatitis) may be the most common pediatric condition seen by dermatologists, however, a similar rash may actually be an allergic reaction (allergic contact dermatitis, poison Ivy), the result of a nutritional deficiency such as biotin or zinc (acrodermatitis enteropathica), an immune (complement) deficiency or a genetic disorder such as Netherton’s syndrome and ichthyosis. All of these would have findings in a skin biopsy that may suggest the correct diagnosis.

Are you seeing a rheumatologist for arthritis? It may take a dermatology examination and a skin biopsy to confirm that you actually have psoriasis and psoriatic arthritis or a connective tissue disease such as lupus. A pulmonary doctor or eye doctor may request a skin biopsy to determine if you have sarcoidosis, a systemic granulomatous disorder that may affect any organ, most often the skin, lungs, eyes and joints.

Infectious disease doctors and internists have long been closely allied with dermatology. All forms of sexually transmitted diseases, to include syphilis and condyloma (venereal warts) have prominent cutaneous signs, and some of the defining conditions in AIDS, such as Kaposi’s sarcoma and bacillary angiomatosis, were revealed by skin biopsy. Vasculitis, an inflammation of blood vessels that may involve any organ, often appears in the skin as non-blanching red papules. A biopsy is critical to establish the diagnosis. You may not realize you have diabetes until a dermatologist biopsies the yellow-orange plaque on your leg and finds necrobiosis lipoidica diabeticorum, a condition closely associated with diabetes mellitus.

In many ways we are fortunate that the skin is such an “accessible” organ and at the same time the outward sign of so many diseases and conditions. If you simply have an irritating “mole’, a new pigmented lesion, a rash you can’t explain or any problem involving the skin, hair and nails, you would be best served by seeing a dermatologist. If a skin biopsy is suggested and you wonder why, you now know that it is often reassuring, sometimes revealing and occasionally surprising.

Grossing, embedding, processing, and routine H&E staining of skin biopsy specimens by our own experienced

laboratory personnel.

• Meticulous and systematic orientation of skin excisions for evaluation of margin involvement by neoplasms.

• Performance of a wide variety of special stains and immunoperoxidase stains.

• Accurate, clear, and prompt diagnoses framed in the language of clinical dermatology.

Routine review of all malignant melanomas, unusual malignant neoplasms, and difficult inflammatory

conditions by a minimum of two dermatopathologists.

• Diagnostic consultations on slides prepared by outside laboratories.

• Proficiency review of slides prepared and previously diagnosed by contributors.

• Telephone or e-mail consultations with any of our staff dermatopathologists.

• Personal telephone contact by STDL office staff on all cases of malignant melanoma.

Courtesy pick-up service via one of our in-house couriers locally or FedEx, UPS, Lonestar Overnight or private

courier services out-of-town.

• Teaching of dermatology and pathology residents from the University of Texas, BAMC, and WHMC.