skin punch biopsies

January 1, 2010 at 1:04 pm

I would like to echo that a skin biopsy is not nearly as risky/difficult as many other biopsies–mainly because they do not go as deep. The biopsy is only skin deep, which sounds dumb to say, but it is an important point in that there is not injury to important big internal structure–blood vessels, nerves, supportive tissues, etc that make healing a problem and that can cause long term effects. Muscle biopsies are hard to heal because they are deep and disruptive. Sural nerve biopsies are deep and disruptive and done at the ankle. The further down the leg, the harder it is to heal. I have not seen a skin punch biopsy ever done below the midcalf. Any procedure has risks and benefits. A skin punch biopsy may show small fiber neuropathy or vasculitis. It has a small risk, potential benefit and the balance is that even if it does not show something, the risk is small. A sural nerve biopsy also has a relatively small chance of showing a definite answer, but the difference is that the risk is much greater. Some doctors focus on the benefit–that it is does show an answer, that is a really good thing. Most now focus on the chances–that the likelihood of showing an answer is small and the risk is moderate or more to have long term concerns with healing or numbness or pain.
Regarding how hard skin punch biopsies are, they are pretty easy. I have not ever had one, but have seen children–even young children have one done to them (for other reasons than this) and they can do it okay if is explained well to them and there is good numbing of the skin (topical anesthetic and use of lidocaine to the area).
All this being said–it is important that the pathologist looking at the skin biopsy is good about looking for signs of inflammation and changes in nerves because the issue is not the skin, but the other small parts (nerves and blood vessels) in the skin.
WithHope for a cure of these diseases