What are the steps to order a pathology test on a punch biopsy?

Ordering a Pathology Test on Punch Biopsy

To properly order a pathology test on a punch biopsy, you must obtain a full-thickness skin specimen including a cuff of subdermal fat, place it immediately in formalin, and submit it with a comprehensive pathology request form containing all relevant clinical information. 1, 2

Specimen Collection and Handling

1. Perform the punch biopsy correctly:

   • Use a 2-3 mm circular punch for diagnostic biopsies 2
   • Include full thickness of skin with subdermal fat 1
   • Avoid crush artifact by handling the specimen minimally 2

2. Specimen preservation:

   • Place the specimen directly into formalin immediately after collection 2
   • Ensure the container is properly labeled with patient information

Completing the Pathology Request Form

The pathology request form must include:

• Patient identification details (full name, date of birth, medical record number)

• Specimen details:

  • Anatomic location of biopsy (be specific)
  • Type of procedure performed (punch biopsy)
  • Size of punch used (e.g., 2mm, 3mm, 4mm)
  • Date and time of collection

• Clinical information:

  • Clinical appearance of the lesion
  • Duration of the lesion
  • Relevant clinical history
  • Differential diagnosis considerations
  • Any prior treatments to the area 2

• Physician information:

  • Ordering physician's name and contact information
  • Where to send results
  • Urgency of the request if applicable

Common Pitfalls to Avoid

• Inadequate specimen: Ensure the punch biopsy is deep enough to include subcutaneous fat for proper histological assessment 1
• Crush artifact: Handle the specimen gently with forceps at the edges only or use a needle to transfer it 2
• Incomplete clinical information: Failure to provide relevant clinical history may lead to misdiagnosis
• Improper fixation: Delayed placement in formalin can cause tissue degradation
• Selecting wrong biopsy site: For suspected melanoma or large lesions, select the thickest or most suspicious area 2

Special Considerations

• For pigmented lesions, document lesion characteristics thoroughly (size, border, color variations) 2
• For suspected melanoma, note that punch biopsy is acceptable for facial or acral lesions, very large lesions, or when complete excision isn't feasible 2
• For lentigo maligna on the face, an initial incisional biopsy is appropriate 1

By following these steps meticulously, you will ensure that the pathologist receives an optimal specimen with all the necessary clinical context to make an accurate diagnosis, which is crucial for determining appropriate treatment and patient outcomes.