Indications for skin biopsy

Indication	Clinical presentation	Possible diagnosis	Biopsy technique
Diagnosis	Rashes or blisters involving dermis	Drug reaction Cutaneous lymphoma^* Deep tissue infection Erythema multiforme Kaposi sarcoma Lupus erythematosus Pemphigoid Psoriasis Vasculitis	Punch
Diagnosis	Processes involving the subcutis	Panniculitis (eg, erythema nodosum)	Excision or telescoping punch^¶
Diagnosis and treatment	Atypical moles and pigmented lesions	Dysplastic nevi Malignant melanoma	Excision or punch (for small lesions)
Diagnosis and treatment	Superficial lesions	Actinic keratoses Basal cell carcinoma Seborrheic keratosis Pyogenic granuloma^Δ Skin tags Squamous cell carcinoma Warts	Shave (into dermis for suspected malignancy) or excision

* Some pathologists may prefer broad shave for conditions mostly involving the epidermis and dermato-epidermal junction, such as differentiation of cutaneous T cell lymphoma from eczematous dermatitis and psoriasiform from eczematous dermatitis. Consider a discussion with pathologist, when possible.

¶ UpToDate also suggests a "telescoping" punch biopsy as an alternative to incisional biopsy to sample subcutaneous tissue.

Δ Pyogenic granuloma may also be removed with a curette and cautery of base.

Graphic 67185 Version 3.0

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Indications for skin biopsy