From the Guidelines
To indicate on a pathology report that a small punch biopsy was taken from a large lesion, you should include a clear statement in the specimen description section such as: "Punch biopsy (X mm in diameter) of a larger cutaneous lesion (approximately Y cm in diameter) from the [anatomic location]." This provides important context for the pathologist and clinicians reviewing the report, as noted in guidelines for managing primary cutaneous melanoma 1. You should specify the exact size of both the biopsy specimen and the entire lesion when possible, as this size discrepancy may impact diagnostic interpretation. Additionally, include relevant clinical information about the lesion's appearance, duration, and any prior treatments in the clinical history section. This contextual information is crucial because a small biopsy may not be representative of the entire lesion, potentially leading to sampling error, especially in heterogeneous lesions like melanoma or other skin cancers where different areas may show varying histological features. The principles of biopsy, including the preference for excisional biopsy with 1-3 mm margins and the consideration of full-thickness incisional or punch biopsy for certain sites or large lesions, are outlined in guidelines from the Journal of the National Comprehensive Cancer Network 1. However, the most recent and highest quality study 1 emphasizes the importance of clear documentation of the biopsy specimen and lesion size, as well as other histologic features, for accurate staging and management. Key elements to be reported include Breslow thickness, histologic ulceration, dermal mitotic rate, and peripheral and deep margin status, as recommended by the College of American Pathologists and other international pathology groups 1. By following these guidelines and including essential information in the pathology report, clinicians can make informed decisions about patient care and management.
From the Research
Pathology Report Description
To describe a small punch biopsy of a large lesion on a pathology report, consider the following points:
- The report should indicate that the biopsy was a punch biopsy, which is a technique used to obtain a full-thickness skin specimen 2.
- It should be noted that the biopsy was small compared to the size of the lesion, as punch biopsies typically yield a 3- to 4-mm cylindrical core of tissue sample 2.
- The report may also mention that the biopsy was taken from a specific area of the lesion, and that the lesion itself was larger than the biopsy sample.
- The pathology report should include a description of the biopsy specimen, including its size, shape, and any notable features 2.
Biopsy Techniques
Different biopsy techniques are available, including:
- Shave biopsy: used for raised lesions 3
- Saucerization biopsy: used for flat or pigmented lesions 3
- Punch biopsy: yields full-thickness samples and can be used for lesions that require dermal or subcutaneous tissue for diagnosis 2, 3
- Elliptical excisional biopsy: a more time-consuming and invasive procedure that may be used for lesions that require a larger sample 3
Reporting Considerations
When reporting the results of a punch biopsy, it is essential to consider the following: