Punch biopsy is performed in the evaluation of inflammatory disorders and occasionally as an initial biopsy for neoplasms.
Read the requisition form first (very important)! This will tell you how to go about processing the specimen.
Vesiculobullous (blistering) disorders (refer to a dermatopathology textbook for examples): Do not bisect the specimen! The vesicle/blister/bulla needs to be submitted intact to histology. If you bisect it, you may detach the blister roof and significantly limit histologic evaluation. You do not need to ink the margins.
Non-bullous inflammatory disorder of any kind: Specimens with a skin surface diameter of 3 mm or less should not be bisected. Specimens with a skin surface diameter of 4 mm or greater should be bisected perpendicular to the skin surface (i.e. going through both skin and fat). It is helpful to cut slightly off center, so that one half is a little bit larger than the other half; this way, less of a centrally-located lesion will be cut through when the block is faced.
Neoplasm/tumor: Ink the margins, both peripheral and deep. Use the rules of bisecting in 2.b. above.
Measure the skin surface diameter and the depth of excision. Use nomenclature of dermatology to describe any lesions.
Occasionally, you may receive a punch biopsy which looks as if a piece has been chopped off. The submitting physician may have sent a portion to microbiology for culture, as a separate specimen for immunofluorescence studies (see Skin: Immunofluorescence Studies), or to another lab as part of a research protocol or for other special studies. Describe it as a semicircular punch biopsy.
Received without fixative/in formalin, labeled _____ and “_____”, is a __ (diameter) x __ (length) cm skin punch biopsy. The skin surface is ___ (color) with ___ (centrally / eccentrically located) ___ (color-- darkly pigmented, red) ___ (configuration-- papule, macule etc) measuring __ cm in diameter with ___ (border). The biopsy is longitudinally bisected to reveal a depth of __ cm of the lesion on the cut surface. Entirely submitted in cassette #__ .