Biopsy Techniques

  • For pigmented lesions, removing the entire lesion where cosmetically / functionally possible is generally recommended. Shave, punch or elliptical excision may be suitable, depending on the lesion. Where a biopsy does not include the entire lesion, please note this on the Request form.
  • For inflammatory dermatoses, a punch biopsy is ideally suited to evaluate the characteristic pattern of inflammation in the epidermis, dermis or subcutis.
    For any questions, call the laboratory at (336) 760-1388.


  • The majority of biopsy and excision specimens should be submitted in formalin containers provided by the lab. Ideally, there should be at least several times the volume of formalin in the container compared to the volume of the specimen.
  • Specimens intended for frozen section must not be placed in formalin or other fixative. Before obtaining the specimen, contact the pathologist at (336) 760-1388 to coordinate timing of the procedure. Stat courier pickup is necessary to minimize turnaround time (for phone numbers, see Contact Information section). Frozen section specimens should be placed in a sterile, dry container, on a saline moistened gauze to prevent dessication in transit (especially important for small specimens). Ensure the request form notes how the pathologist can contact the physician or other provider who is waiting for the results.
  • Immunobullous diseases- If direct immunofluorescence is indicated, be sure to select perilesional skin, and submit in Michel’s fixative. This is listed on the Supply Request Form, and available by calling (336) 760-1388, ext 200. A fresh skin or mucosal sample is good for about five days in transport medium at room temperature, but ideally should be sent promptly to the laboratory.
  • For pemphigus, five to ten (5 to 10) ml of serum for indirect immunofluorescence is taken in a red-top or tiger-top tube, ideally a serum separator type tube with the gel at the base which assists clotting and serum separation. The specimen is spun down and the serum taken off for processing. The serum is suitable for testing for several days, but if held overnight in the office can be refrigerated, but not frozen.
  • For cases where lymphoma or leukemia cutis is suspected, and flow cytometry is indicated, transport in Cytochex allows preservation of the sample. Cytochex is listed on the Supply Request Form, and available by calling (336) 760-1388, ext 200. Cytochex containers are kept at room remperature. Once a specimen is placed in the container it should be sent promptly to the lab. If it must be kept overnight in the doctor’s office, it should be refrigerated, but NOT frozen.
  • Rocky Mountain spotted fever (RMSF) was formerly detectable by frozen section immunofluorescence tests, but at the time of writing, this test is no longer available. Candidate specimens for RMSF should be submitted fixed in formalin for conventional paraffin-section H&E examination.


  • Courier services are available. For directions on correct courier routing, call (336) 760-1388.
  • FedEx and UPS transportation may be used for more distant offices.