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Nonspecific histopathological diagnoses: the impact of partial biopsy and the need for a consensus guideline.

Partial skin biopsies have an impact on histopathological diagnoses. In March 2010, JAMA Dermatology published a study that found increased odds of misdiagnosis and microstaging inaccuracy of punch and shave biopsies for melanomas over excisional biopsies.1 In a subsequent comment on an opinion piece about biopsy technique and specimen size,2 Stratman3 highlighted the lack of consensus guidelines for correct biopsy techniques. Since then, nothing has changed. The American Academy of Dermatology has developed numerous clinical guidelines regarding office-based surgery, liposuction, atopic dermatitis, and so on, but a consensus guideline for adequate biopsy techniques is still missing. The subject is frustrating for dermatologists and dermatopathologists alike. Even more common than misdiagnoses are nonspecific and descriptive diagnoses that dermatopathologists are almost “forced” to issue when a biopsy is inadequate. Two examples are shown in the Figure. Specimen 1 (Figure, A-D) represents a shave biopsy from the left upper cutaneous lip of a woman in her 70s in which the clinician suspected a basal cell