Skin Biopsies in the Rheumatology Clinic

3.0 mm Punch Biopsy of the Skin

The Tools Needed

1. Alcohol Swabs 
2. 3 cc syringes with 22 gauge needle on it 
3. 30 gauge ½ inch needles
4. A bottle of 1% lidocaine WITH epinephrine
5. 3.0 mm punches for the biopsy
6. Disposable scalpels
7. 75% silver nitrate/25% potassium nitrate stick for hemostasis control
8. Band aid
9. Formalin – Needed for H&E staining
10. Michel’s Solution (transport Medium) – Needed for Immunofluorsecence – Is in a 15 mL container which needs to be refrigerated.

The Technique

1. Identify the lesion to be biopsied.
2. Biopsy the edge of the lesion as this is where most of the new inflammatory activity is taking place.
3. IMPORTANT: If you want both H&E staining and Immunofluorescence you will need to take two separate biopsies.
4. Alcohol over the area
5. Draw up 1% lidocaine with epinephrine with the 3cc syringe with the 22 gauge needle attached.
6. Remove the 22 gauge needle and attach the 30 gauge ½ inch needle on the 3cc syringe.
7. Freeze the skin with the lidocaine with epinephrine using the 30 gauge needle with 1-2 cc’s (the area will blanch – a good thing to control bleeding).
8. Insert the punch biopsy to the hilt in thick skin (legs/back) and less in thinner skin (dermis is thinner) on the face and scalp.
9. Remove the punch and your specimen is still attached to the skin.
10. With the 30 gauge needle “skewer” the biopsy sample and lift it up, then cut the tissue away with the disposable scalpel
11. Sample Transfer:
    a. For H&E Stains: Put the tissue in FORMALIN and send to Pathology
    b. For Immunofluorescence (IMF): Put the tissue in Michel’s transport medium and send to Pathology.  Michel’s solution needs to be refrigerated.
12. The hole the core biopsy came out of might bleed a bit.  Stick a silver nitrate stick in the hole and swirl it around to cauterize the wound.
13. Cover the wound with a bandaid
14. Tell the patient to wash the wound with warm soapy water everyday, pat dry and apply polysporin and then a new bandaid.  Don’t pick off the scabs!