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Background: Research biopsies have great potential to advance scientific knowledge by helping to establish predictors of favourable or unfavourable outcomes in kidney transplantation. We evaluated punch and core biopsies of different sizes to determine the optimal size for clinical use. Methods: A total of 54 punch biopsies and 18 core needle biopsies were retrieved by three transplant surgeons. Each surgeon obtained three separate 2 mm, 3 mm and 4 mm punch biopsy samples and three 23 mm (length) core needle biopsies from two pig kidneys. Results: 4 mm punch biopsies yielded the greatest amount of protein (2.11 ± 0.41 mg) with good reproducibility between surgeons and biopsy types (Coefficient of Variation ∼ 22.13%). All surgeons found 2 mm biopsies technically challenging to obtain and sample processing was difficult due to the sample size. Shotgun proteomics identified 3853 gene products with no significant difference in the quantitative proteome of 2 mm and 3 mm punch biopsies. However, the expression of 158 Kidney enriched genes, was higher in bigger and deeper 4 mm punch and core needle biopsies compared to 2 mm biopsy. Only 80% of 2 mm biopsies demonstrated the presence of glomeruli, whereas glomeruli were present in 100% of all other biopsy sizes. Conclusions: The 2 mm punch biopsy has been shown to be challenging to use and frequently provides inadequate tissue for histology and proteomics while 3 mm research biopsies were the smallest size that were technically obtainable with adequate tissue for molecular studies. [ABSTRACT FROM AUTHOR]

Abstract Background Despite the popularity and usage of tattoos in modern society, various complications can occur such as allergic tattoo reactions, infections, tattoo removal complications and chronic granulomatous inflammatory tattoo reactions such as sarcoidosis. Histopathology of skin biopsies in tattoos is crucial in the diagnostic process of complications. As tattoos are frequently obtained for cosmetic reasons, cosmetic consequences of a skin biopsy in a tattoo are important. Remarkably, no studies have been performed regarding the consequences and expected outcome of taking a punch biopsy of tattooed skin. Objectives The objective of this study is to report on the possible complications and patient‐reported cosmetic outcomes after punch biopsies in tattooed skin. Specifically, this study aims to assess the impact on appearance, symptoms and psychosocial burden of biopsies in tattooed skin, using the SCAR‐Q. Methods Patients who underwent a punch biopsy of tattooed skin at the Tattoo Clinic in the Alrijne Hospital between 2021 and 2023 were included. To evaluate patient satisfaction of the biopsy scar the SCAR‐Q and a questionnaire regarding the recovery of the punch biopsy was used. Results The final cohort consisted of 50 patients. Across all scales, the median scores on the SCAR‐Q questionnaire were consistent with the maximum score. Patients scored significantly better on the appearance scale when the biopsy was taken longer than 8 months ago. Two‐third of the patients reported no postbiopsy symptoms, with the remainder experiencing itch, pain or redness, which typically resolved within 10 days (88%). Remarkably, 42% of the patients reported the biopsy scar was not visible on the skin anymore. Scars on the lower extremities and trunk were significantly more frequently visible, as well as scars among patients aged 40 and above. Conclusions This study demonstrates that the cosmetic and psychological impact of punch biopsies in tattooed skin is minimal and the recovery is fast with minimal symptoms. For this reason, biopsies of tattooed skin should not be avoided in the diagnostic process.

Abstract Purpose To report a rare non-endemic case of Leishmania aethiopica in Washington DC. Case report A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms. Conclusion This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment.

Purpose: To report a rare non-endemic case of Leishmania aethiopica in Washington DC. Case report: A 68-year-old female presented for a routine examination with a complaint of right upper eyelid lesions for the past 5 months. On examination, a cluster of elevated and erythematous lesions extending from the medial canthus to the brow area of the right eye were seen. Initial treatment with Valtrex based on a suspected viral etiology failed. Although a biopsy was recommended at this time, the patient declined, and subsequent workup included nasolacrimal duct irrigation, blood work to rule out autoimmune etiology, a course of doxycycline, and an MRI, which yielded no improvement. Upon progression of the lesions into persistent plaques on the eyelids, a punch biopsy was performed, confirming leishmaniasis. The patient was then started on a 28-day course of oral miltefosine which led to complete resolution of her symptoms. Conclusion: This case underlines the importance of a broad differential including non-endemic diseases, particularly in urban areas with frequent patient travel. Furthermore, the delayed punch biopsy in this case highlights the importance of patient counseling to ensure prompt diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: The standard diagnosing Hirschsprung disease is obtained by pathologic evaluation. There are several techniques to acquire pathologic sample included Full Thickness Biopsy, Rectal Suction Biopsy, Punch Biopsy, and Endoscopic Biopsy. Currently, the endoscopic device is widely available and its utility is more frequent in pediatric population. This study conducted to compare the effectiveness in diagnosing Hirschsprung disease using the Colonoscopy Forceps Biopsy (CFB) and full thickness biopsy (FTB) method as a gold standard. Method: A preliminary study of the pathologic evaluation in 10 children clinically Hirschsprung disease who underwent two types of biopsy procedures: full-thickness biopsy and colonoscopy forceps biopsy. This study aimed to compare the diagnostic result of these two methods. Results: The biopsy results indicate that 10 FTB samples were aganglionic, while 9 samples taken using CFB were aganglionic. Conclusion: Colonoscopy with forceps biopsy may be used as an alternative for the diagnosis of Hirschsprung’s disease in children, further studies are needed to assess the diagnostic accuracy of colonoscopy with forceps biopsy. [ABSTRACT FROM AUTHOR]

Intravascular large B-cell lymphoma (IVLBCL), a rare subtype of malignant lymphoma, is diagnosed by observation of intravascular proliferation of tumor cells in samples taken from affected organs. However, diagnosis of IVLBCL is usually difficult due to the lack of mass formation. IVLBCL may be fatal when the diagnosis is delayed, so an accurate early diagnosis is the key to successful treatment. Random skin biopsy (RSB), in which specimens are sampled from normal-appearing skin, has been reported as useful. However, the specific method of RSB remains controversial, with individual institutions using either the punch method or the incisional method. Research has shown that the incisional method has higher sensitivity than the punch method. We discuss whether this difference might owe to the collection of punch specimens from an insufficient depth and whether the punch method might result in false negatives. For RSB, we recommend taking specimens not only from normal-appearing skin, but also from any lesional skin, because lesions may reflect micro IVLBCL lesions. To ensure accurate diagnosis, both dermatologists and hematologists should know the proper method of RSB. This review summarizes the appropriate biopsy method and sites for RSB. [ABSTRACT FROM AUTHOR]

Background: Skin diseases are common and divergent. Skin is the largest external organ of the body and it's repeatedly exposed to microbial and non-microbial antigens from environment. This leads to enormous number of diseases that can occur in skin. Skin lesions are categorized broadly as non-neoplastic and neoplastic diseases. Preponderance of skin lesions are non-neoplastic. Aim: To determine the histopathological patterns of non-neoplastic skin lesions received at a tertiary care institute Materials and Methods: A cross-sectional study conducted between November 2022 to October 2023.skin punch biopsy specimens received during the study period were submitted for processing. Tissue processing was done as per standard procedure and paraffin embedded blocks were made Special stains such as FiteFaraco stain were performed whenever required. Results: A total of 126 cases of skin lesions were taken up for the study in which a conclusive diagnosis of nonneoplastic skin lesion were made. Out of these, 88 cases were male patients while 38 were female patients. Most cases belonged to 31-40 years age groups - 30 cases. In our study, Noninfectious vesiculobullous and vesiculopustular diseases constituted maxim um number of cases 42 (33.3%). Conclusion: Histopathology is an important diagnostic tool in skin lesions,despite advancement in molecular techniques in diagnosis and prognosis, morphology still remains the basis of diagnosis. [ABSTRACT FROM AUTHOR]

Background: The heterogeneity of rectal biopsy techniques has encouraged us to search for a surgical and pathological standardisation of this diagnostic technique to exclude Hirschsprung's disease. The different amounts of information on the anatomopathology report prompted us to compile a template for the anatomopathology report for diagnostic rectal biopsies for surgical colleagues and pathologists working on Hirschsprung's disease. Methods: We gathered the anonymous biopsy information and its pathology information from five hospitals for all patients in which rectal biopsies were taken to diagnose Hirschsprung's disease over two years (2020–2021). Results: Of the 82 biopsies, 20 suction (24.4%), 31 punch (37.8%) and 31 open biopsies (37.8%) were taken. Of all biopsies, 69 were conclusive (84.2%), 13 were not (15.8%). In the suction biopsy group, 60% were conclusive and 40% were not; for punch biopsy, the values were 87% and 13%, respectively and for open biopsy, 97% and 3%. Inconclusive results were due to insufficient submucosa in 6/8 suction biopsies, 4/4 punch biopsies and 0/1 open biopsies. An insufficient amount of submucosa was the reason for an inconclusive result in 6/20 cases (30%) after suction biopsy, 4/31 (12.9%) cases after punch biopsy and 0 cases (0%) after open biopsy. We had one case with major postoperative bleeding post suction biopsy; there were no further adverse effects after biopsy. Conclusions: Diagnostic rectal biopsies in children are safe. Non-surgical biopsies are more likely to give inconclusive results due to smaller amounts of submucosa present in the specimen. Open biopsies are especially useful when previous non-surgical biopsies are inconclusive. An experienced pathologist is a key factor for the result. The anatomopathology report should specify the different layers present in the specimen, the presence of ganglion cells and hypertrophic nerve fibres, their description and a conclusion. [ABSTRACT FROM AUTHOR]

The most commonly detected non-melacytic skin tumor in humans is "basal cell carcinoma". There are many clinical varieties of this tumor, some of which are quite rare. The attention of specialists is brought to the attention of a clinical observation of an elderly woman who was observed on an outpatient basis by a dermatologist with a rare form of basal cell carcinoma of the skin of the back. Of particular interest is a long history of the disease for about 15 years, the presence of a scar-like large lesion on the back of more than 11 cm in diameter, the absence of lymphadenopathy and weight loss, with a histologically confirmed sclerodema-like basalioma of the skin.

Translational research has improved patient care over the last decade. In dermatology, this research often requires human tissue for laboratory analysis. The skin biopsy remains the gold standard for tissue acquisition, but the procedure comes with a small risk of bleeding and infection. It also causes scarring and anxiety in certain populations. These risks and concerns may affect participation rates in translational studies, which can require multiple biopsies. Minimally invasive procedures may mitigate these risks and concerns. We queried the PubMed database for all minimally invasive technologies studied as of May 2021. Of the 53 articles reviewed, we identified 13 unique, minimally invasive methods for tissue biosample acquisition. Herein, we describe each sampling method, biosample type analyzed, disease target, molecular application, procedure, quantity of obtained biosample, purpose, and required equipment. We organize this information into a comprehensive chart. We then synthesize this information into another table that compares the pros and cons of each intervention. We found that tape stripping, suction blistering, hair plucking, microbiopsy, and microneedle patching provide a variety of useful biosample types for laboratory analysis. In translational research, these technologies have the potential to replace more invasive methods like the punch biopsy, likely improving participation in studies.

Background: Cervical PAP smear examination is an ideal investigation for early detection of benign and malignant conditions of uterus because cervical infections are commonly encountered problems in women during their reproductive age and in some cases in post-menopausal. Method: Out of 3980 female patients aged between 21 to 80 years 3910 (98.2%) patients had pathological significance. Cervical smear were prepared by using disposable ayle’s spatula fixed in 95% of alcohol and stained by conventional PAP techniques and interpreted according to guidelines of 2001 Bethesda system. Results: 1800 (46%) ASCUS, 230 (5.88%) AGUS, 500 (12.7%) LSIL, 480 (12.2%) HSIL, 650 (16.6%) SCC, 200 (5.11%) malignant positive, 50 (1.27%) adeno carcinoma were studied 700 (38.8%) chronic cervicitis in ASCUS, 112 (48.6%) chronic cervicitis in AGUS, 298 (59.6%) chronic cervicitis, 98 (19.6%) Decubitis ulcer in LSIL, 60 (12.5%) reparative change, 120 (25%) chronic cervicitis, 120 (25%) chronic cervicitis, 120 (25%) micro INV CA, 120 (25%) CIN were observed in HSIL 630 (96.9%) SSC, 20 (3.07%) adenocarcinoma in SCC study and 50 (1.27%) were studied. Conclusion: The PAP smear will be a tool for screening of cervical intra epithelial lesion and it is cost-effective, useful for pathologist OBG and Gynaecologist and oncology surgeon to treat such patients to avoid morbidity and mortality. [ABSTRACT FROM AUTHOR]

The authors analyzed the risk factors of punch biopsy by investigating the complications of the technique and their proportions. Patients who underwent punch biopsy in a dermatology clinic between November 2018 and November 2020 (n = 1294; mean age, 62.3 years; 540 men and 754 women) were enrolled in the current study. The most common complication was postoperative bleeding (0.9%). Wound infection (0.2%), surrounding skin damage (0.2%), and vagal reflex (0.1%) were also observed. The main risk factors for bleeding following biopsy were location of biopsy site outside of the trunk (odds ratio [OR], 4.60 [95% CI, 2.65–8.00]; p < 0.001) and platelet count lower than 150 000/μL (OR, 2.82 [95% CI, 1.69–4.73]; p < 0.001). When performing a punch biopsy, an adequate explanation of the risks and complications should be provided before obtaining informed consent. Further, blood sampling tests should be performed in advance and the types of cases that may require wound suture should be appropriately determined. [ABSTRACT FROM AUTHOR]

Background: With negative side effects of a lengthy healing time and high complication rate, cleft palate surgery is employed to treat cleft palate, which is a common congenital anomaly. Honey is believed to help accelerate wound healing post-treatment. However, its effect on the increase in the transforming growth factor (TGF)-β1 expression after palate surgery is unclear. Objective: This study investigates the effect of forest honey on TGF-β1 protein expression levels in the wound healing palate model. Methods: This study evaluates the TGF-β1 protein expression of a palatoplasty wound model using enzyme-linked immunosorbent assay. For this purpose, a punch biopsy model with 30 Sprague-Dawley rats is treated with forest honey (TG), Aloclair Gel (PC), and distilled water (NC) for 3 days. Analysis of the TGF-β1 expression on day 4 is performed by statistical one-way analysis of variance and post hoc least significance difference, with a 0.05 significant P-value. Online website software helped to predict the effect of honey components on the TGF-β1 expression. Results: Protein levels of treatment group (T), negative control (NC), and positive control (PC) exhibit mean levels of 16.13 ± 1.06883 ng/L, 7.36 ± 0.16543 ng/L, and 15.03 ± 0.34221 ng/L, respectively. The differential expression T group exhibits a 2.19-fold change in TGF-β1 relative to the NC group and a 1.07-fold change in the PC group (P-value of 0.01). TGF expression in the PC group increases in comparison to that in the NC group by 2.04-fold (P-value of 0.01). In-silico analysis revealed that genistein promotes macrophage proliferation and activation via the increase in the TGF-β1 expression. Conclusion: In summary, forest honey can boost the TGF protein expression via genistein to increase macrophage proliferation and activation.

Background: The heterogeneity of rectal biopsy techniques has encouraged us to search for a surgical and pathological standardisation of this diagnostic technique to exclude Hirschsprung’s disease. The different amounts of information on the anatomopathology report prompted us to compile a template for the anatomopathology report for diagnostic rectal biopsies for surgical colleagues and pathologists working on Hirschsprung’s disease. Methods: We gathered the anonymous biopsy information and its pathology information from five hospitals for all patients in which rectal biopsies were taken to diagnose Hirschsprung’s disease over two years (2020–2021). Results: Of the 82 biopsies, 20 suction (24.4%), 31 punch (37.8%) and 31 open biopsies (37.8%) were taken. Of all biopsies, 69 were conclusive (84.2%), 13 were not (15.8%). In the suction biopsy group, 60% were conclusive and 40% were not; for punch biopsy, the values were 87% and 13%, respectively and for open biopsy, 97% and 3%. Inconclusive results were due to insufficient submucosa in 6/8 suction biopsies, 4/4 punch biopsies and 0/1 open biopsies. An insufficient amount of submucosa was the reason for an inconclusive result in 6/20 cases (30%) after suction biopsy, 4/31 (12.9%) cases after punch biopsy and 0 cases (0%) after open biopsy. We had one case with major postoperative bleeding post suction biopsy; there were no further adverse effects after biopsy. Conclusions: Diagnostic rectal biopsies in children are safe. Non-surgical biopsies are more likely to give inconclusive results due to smaller amounts of submucosa present in the specimen. Open biopsies are especially useful when previous non-surgical biopsies are inconclusive. An experienced pathologist is a key factor for the result. The anatomopathology report should specify the different layers present in the specimen, the presence of ganglion cells and hypertrophic nerve fibres, their description and a conclusion.

Background: In developed countries, cervical cancer is the second most prevalent cancer between females. When it enters the invasive phase, but outside of all female genital tract cancers, cervical cancer is a deadly disease. If diagnosed in its early stages, it is the only preventable cancer, and the disease is almost 100% curable with accurate screening and early detection. The aim of the work: To determine the effectiveness of both office cervicoscopy and colposcopy-directed biopsy in the assessment of clinically suspicious cervix. Patients and Methods: A prospective randomized controlled study, held on 200 patients randomly selected used closed envelopes with clinically suspicious cervix attending the outpatient clinic of Obstetrics and Gynecology Department, Al-Azhar University Hospital [Assiut]. Results: In case of inflammatory cases, the sensitivity with the pathology results were 97.7%, and 98.1% for colposcopy and office cervicoscopy respectively and specificity were 84.3%, and 94.7% for colposcopy and office cervicoscopy respectively. In case of abnormal vasculature, the sensitivity with the pathology results were 33.3%, and 85% for colposcopy and officecervicoscopy respectively and specificity were 80%, and 94.4% for colposcopy and office cervicoscopy, respectively. Conclusion: Colposcopy and office cervicoscopy have the same sensitivity and specificity for the detection of cervical polyps. But, in case of inflammatory and abnormal vasculature, office cervicoscopy was more sensitive with higher specificity than colposcopy more over office cervicoscopy had a great benefit in the assessment of endocervical canal and uterine cavity so, office cervicoscopy and colposcopy are complementary to each other.

This article discusses the resolution of basal cell carcinoma (BCC) following a diagnostic periocular punch biopsy and the possibility of surveillance as a management option. The study reviewed case notes of patients who underwent a 4mm punch biopsy at a UK hospital between 2005 and 2019 and were confirmed to have BCC. Out of 392 patients, 14 had complete resolution of their BCC lesion following the punch biopsy and opted for surveillance instead of further excision. The incidence of BCC resolution following punch biopsy in this cohort was 3.6%. The study suggests that surveillance may be a reasonable management option for a small subset of patients with small BCCs that have resolved after biopsy, particularly of the nodular histopathological type. However, careful consideration of risks and longer follow-up periods are necessary. [Extracted from the article]

Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins.

Objective: The vast majority of breast cancers are diagnosed via image-guided procedures yet despite significant advances, imaging does not identify all breast malignancies. Clinically suspicious breast lesions with normal breast imaging remain a cause for concern. The aim of this study is to determine the diagnostic value of clinical core and cutaneous punch biopsies in the diagnosis of breast malignancy in clinically suspicious lesions with normal breast imaging. Methods: All patients with suspicious clinical breast findings and normal imaging who underwent a clinical core and/or cutaneous punch biopsy from 2012 to 2019 were reviewed retrospectively. Patients with subsequent breast malignant diagnosis were analysed. Results: A total of 283 biopsies (166 clinical core, 117 cutaneous punch) performed over the 7-year period were included in the analysis. A total of 263/283 (93%) yielded a benign outcome. A total of 2/283 (0.7%) yielded B3 lesions (probably benign). These lesions were benign on final surgical excision. A total of 18/283 (6.3%) yielded a malignant histopathology. Sixteen out of 18 were cutaneous punch biopsies, and 2/18 were clinical core biopsies. A total of 14/18 patients presented with nipple changes, while 4/18 had a palpable area of concern. Histopathological analysis demonstrated Paget's disease of the nipple in 8/18, invasive carcinoma in 9/18 out of which two represented a recurrence of breast malignancy. Cutaneous squamous cell carcinoma was diagnosed in 1/18. Conclusion: Clinical core and cutaneous punch biopsies remain a valuable tool in the diagnosis of breast cancer particularly in the management of clinically suspicious radiographically occult malignancies. [ABSTRACT FROM AUTHOR]

Background:Cutaneous vasculitis is inflammation of small- or medium-sized vessels in the skin and subcutaneous tissue. It may be limited to the skin, or may be a component of a systemic primary or secondary vasculitic disorder. Aims: To determine clinical spectrum of cutaneous vasculitis and to compare clinical diagnosis with histopatological diagnosis. Methods: A study was conducted on 94 patients clinically diagnosed as cutaneous vasculitis in the dermatology outdor. Detailed history, clinical examination and baseline workup consisting of complete hemogram, renal function tests, liver function tests, chest X-ray, urine (routine and microscopic) examination besides antistreptolysin O titer, Mantoux test and ANCA antibodies were done. Based on history and clinical presentation, vasculitis was classified according to modified Gilliam.s classification. Punch biopsy was taken and histopathological examination was done and compare with clinical diagnosis. Results: Out of 94 (38 male and 56 female) patients diagnosed clinically as cutaneous vasculitis, 80 were classified as Leukocytoclastic vasculitis (LCV), 4 as Heinoch-Schonlein purpura (HSP), 4 as Urticarial vasculitis (UV), 2 each as Livedoid vasculitis, Nodular vasculitis and Pityriasis lichenoid et varioliforme acuta. On histopathological diagnosis, out of 80 patients of clinically diagnosed LCV, 56 were leukocytoclastic vasculitis, 14 lymphocytic vasculitis and 10 shows no evidence of vasculitis. Out of 4 HSP patients, 2 revealed LCV while two other did not show any evidence of vasculitis. All patients of urticarial vasculitis (UV), livedoid vasculitis and nodular vasculitis were also diagnosed histopathologically as LCV. Two patients diagnosed clinically as pityriasis lichenoid et varioliforme acuta were confirmed on histopathologically. Conclusion: Leukocytoclastic vasculitis was the commonest type of vasculitis, clinically as well as histopathologically. Skin biopsy is essential to confirm clinical diagnosis of cutaneous vasculitis. Leukocytoclastic vasculitis on histopatholgy may be present in Heinoch-Schonlein purpura (HSP), Urticarial vasculitis, Livedoid vasculitis and Nodular vasculitis. Follow up of these patients is neccessary as it may be primary sign of systemic involvement of vascular system. [ABSTRACT FROM AUTHOR]

Abstract is missing (Short communication)

Background: A variety of skin simulators are available on which to practice procedures; however, choice of a suboptimal substitute compromises realism and productive practice.Objective: Skin simulators for basic dermatological procedures are reviewed.Methods: The authors’ anecdotal experience with various skin simulators for different procedures is shared.Results: The following simulators are suggested:  an unripe banana for elliptical excision, pork belly for undermining, pork belly for simple interrupted and buried suture, capped needle on a human shoulder for intramuscular injection, ripe tomato or hotdog with skin for intradermal injection, eggplant for shave biopsy, pork belly for punch biopsy, plastic tape over a dark surface for cryosurgery, and beef liver for electrosurgery.  Flaps are best practiced with foam sandwiched between foam tape or artificial anatomical models created specifically for this purpose.Limitations: The utility of one simulator over another was not compared in a controlled study.Conclusion: Efficient, realistic skin simulators are readily available for practice, which should enhance the safety of the practitioner and improve outcomes of novices.

Verrucous carcinoma is a rare variant of cervical carcinoma, usually occurs in postmenopausal group. Aetiology is still not understood but it is thought to be associated with chronic irritation and inflammation. Histological diagnosis is usually difficult since the pathologic findings may be benign especially if biopsy specimen contains only surface epithelium. Prognosis of this histological subtype is better compared to the well-differentiated Squamous Cell Carcinoma (SCC) of cervix. Author present a case of verrucous carcinoma where patient came for routine check-up and on pelvic examination; cervix was replaced by friable, cauliflower like warty growth, clinically staged as stage 1B. Punch biopsy was taken from the growth and it reported benign pathology but due to high index of suspicion, repeat biopsy was taken and second histopathology also reported benign pathology. Contrast Enhanced Computed Tomography (CECT) whole abdomen was advised as clinical picture and Histopathological Examination (HPE) was not matching. CECT reported mass confined to the cervix, features consistent with carcinoma cervix. So, the patient underwent radical hysterectomy with pelvic lymphadenectomy. Final histopathology reported verrucous carcinoma of cervix. Patient is under regular follow-up and free of disease since 1 year.

Acne is a chronic dermatological disease of pilosebaceous units existing in the form of hair follicles (HFs) and accompanying sebaceous glands. In topical acne treatment, localisation of drug substance at the target site, in pilosebaceous units, especially in HFs is essential. The aims of this study were to develop and optimise adapalene (ADA)-loaded PAMAM dendrimer-based nanocarriers for topical acne treatment and to prepare gel formulations of the selected nanocarriers and to characterise their rheological properties and spreadability. ADA accumulation in HFs and in the skin from PAMAM dendrimers' aqueous colloidal formulations and their gel formulations were quantitatively determined using punch biopsy technique. Follicular targeting efficiency from PAMAM dendrimers and their gel formulation was compared with the commercial gel product, Differin® Gel. The localisation of fluorescently labelled PAMAM dendrimers was visualised using a confocal microscope, which confirmed a successful delivery of the carrier system to the HFs. It was also quantified that PAMAM dendrimers improved follicular localisation and skin deposition of ADA. PAMAM dendrimers' gel formulation including lower ADA doses compared with the commercial product exhibited efficient performance in terms of drug accumulation in HFs. In vitro cell viability studies showed the relative safety of G2-PAMAM dendrimers which could be considered to possibly be well tolerated by the skin. Overall, PAMAM dendrimers' potential to selectively target drugs to the site of action, reduce dose administrated, therefore minimise side effects and provide efficiency in topical treatment of dermatological diseases such as acne was shown. [ABSTRACT FROM AUTHOR]

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Trichoblastomas (TBs) are extremely rare, benign hair germ tumors that can mimic basal cell carcinoma (BCC). They usually arise on the head or neck and have a potential for malignant transformation, albeit it is rare. We report a case of giant TB on the forehead of a 75-year-old otherwise healthy woman. Since the age of 20 she reported a bulge on her forehead, in which a superficial-looking wound had now developed. Initially a dermatologist biopsied the tumor suspecting a BCC, which the histological analyses confirmed. The patient was then referred to the Department of Plastic Surgery for complete excision of the carcinoma, including the large frontal bulge. Surprisingly, the concluding pathology report changed the diagnosis from a BCC to a TB. Current management of most skin lesions relies on the histopathological subtype of a single punch biopsy. Many benign and malignant dermatological entities may mimic BCC, and therefore misdiagnosis can lead to either unnecessary excision or delayed treatment of metastatic disease. Mimics may include various types of nonneoplastic processes, benign adnexal tumors, including TB, or cutaneous carcinomas with basaloid features. A single punch biopsy is not always adequate in making the correct diagnosis. Although it is considered the gold standard, the clinical assessment is just as important. Due to its potential for malignant transformation, it is recommended to excise TB with negative margins. [ABSTRACT FROM AUTHOR]

Introduction: Accurate diagnosis of skin is of utmost importance for management of different skin disorders presenting with the similar clinical signs and symptoms. Therefore to confirm the diagnosis and start treatment biopsy becomes inevitable and for obtaining diagnostic full-thickness skin specimens Punch biopsy is the primary method. Aims & Objective: The present study was to analyse the incidence and age & sex distribution of dermatological disorders presenting to B.J. Medical College, Civil Hospital Ahmedabad (tertiary care centre), Gujarat and access their histopathological profile Materials & Methods: This was a retrospective study carried out at the department of Pathology B.J. Medical College & Civil Hospital, Ahmedabad for a period of 1 year (1st January 2018 to 31st December 2018). With necessary clinical details obtained in a proforma, punch biopsy specimen is sent to the histopathology section for final diagnosis. Formalin fixed, paraffin embedded sections were prepared & slides were routinely stained with H & E and special stains applied wherever necessary. Data obtained was tabulated and analysed. Results: Total 232 cases were analysed. 21-30 years age group constituted 22% of the total cases. Male/ Female ratio is 61/39. Hypopigmented patch/plaque was the most common clinical lesion (27%). Hansen's disease was the most common histopathological diagnosis reported (30%) followed by vesiculobullous lesions (12%). Conclusion: Punch biopsy is a very simple outdoor procedure and very useful for skin lesions. Hansen's disease is still most common skin disease for which biopsy is done followed by vesiculobullous lesion. Tattoo induced granuloma is also a common lesion along with lichenoid lesion. [ABSTRACT FROM AUTHOR]

Background: In instances of suspected cutaneous infection, the standard of care includes obtaining skin biopsy specimens for histology and tissue culture. Few studies have compared the clinical utility of each test.Objective: To assess the concordance of results between tissue culture and histology, as well as the clinicopathologic features that may influence the diagnostic yield of each test.Methods: A retrospective review of all patients who underwent skin biopsy for histology and tissue culture at New York University from 2013 through 2018.Results: Of 179 patients, 10% had positive concordance, 21% had positive tissue culture only, and 7% had positive histology only. We calculated a kappa correlation coefficient of 0.25 between histology and tissue culture (reference, 0.21-0.39 indicates minimal agreement). Histology exhibited higher sensitivity in detecting fungi, whereas tissue culture was more sensitive in identifying Gram-negative bacteria. Antimicrobial use before biopsy led to significantly fewer positive cultures (37.5% vs 71%; P = .023) in patients ultimately diagnosed with infection.Limitations: This study was conducted at a single institution, thereby restricting its broad applicability. The lack of a validated criterion standard to diagnose infection also limits interpretation of the results.Conclusion: Tissue culture and histopathology often yield discordant results. Dermatologists should recognize specific limitations, yet high clinical utility in special circumstances, of tests when approaching cases of suspected infection. [ABSTRACT FROM AUTHOR]

Background: The histological subtype of basal-cell carcinoma (BCC) is often based on a punch biopsy; only a small part is evaluated, possibly leading to misclassification. Consensus on the optimal approach to process punch biopsies is lacking, though accurate subtyping is important for appropriate treatment.Objective: The aim is to investigate whether evaluating 4 levels of a punch biopsy instead of 1 or 2 levels leads to more accurate subtyping of BCC.Methods: In a retrospective study we evaluated 87 punch biopsies of histologically confirmed BCCs. The primary outcome was the proportion of "more aggressive" BCCs (nonsuperficial vs. superficial, infiltrative vs. nodular subtype) that was missed by evaluation on 1 or 2 levels, using 4-level diagnosis as reference standard.Results: Eighty-five cases were available for analysis. Subtyping based on 1 level resulted in discrepancies with 4-level diagnosis in 16.5% of all cases. Underdiagnosis occurred in 14 of 58 nonsuperficial BCCs (24.1%, 95% CI: 13.9-37.2). Seven of 38 nodular BCCs (18.4%, 95% CI: 7.74-34.3) were diagnosed as superficial in 1 level, and 7 of 20 infiltrative BCCs (35%, 95% CI: 15.4-59.2) were diagnosed as superficial (n = 2) or nodular (n = 5) in 1 level.Conclusion: In order to maximize correct subtyping and plan appropriate treatment, we advise to evaluate at least 2, but preferably more, levels of a punch biopsy to determine the BCC subtype. [ABSTRACT FROM AUTHOR]