**3. Conclusion**

a second biopsy was performed at the site of the first or adjacent to it, to make the right

In most instances, the purpose of the biopsy is diagnostic or monitoring, but often ends up being therapeutic,in spite of the fact that it hasn´t been the main objective. That is, for example, when the lesions are small, that is to say entering in a punch of 6 mm or less. It has also been described in cases of basal cell carcinoma or keratoacanthoma in which after diagnostic biopsy at the time of definitive treatment, is not even the primary lesion biopsied. On these cases a second biopsy must be performed to do the correct treatment. In cases where no lesion was

Laboratories in Europe and the USA have increasingly included skin biopsy in the diagnosis assessment or follow-up of patients with **Peripherals neuropathy.** [18] When a skin biopsy is done with this purpose, it can be done at any site of the body. A 3 milimeters diameter punch is commonly used with no need for sutures. For diagnostic purpose, one skin biopsy is commonly done at a distal site on the leg (10 cm above lateral malleolus) and a further biopsy taken at a proximal site on the thigh (20 cm below the iliac spine); thus a proximal site and a distal site can be compared if a length-dependent process is suspected. Skin biopsy can also

Skin biopsy is a safe, minimally invasive, painless and cheap tool to provide diagnostic information on small nerve fibers, which are invisible to routine neurophysiological tests. Sommer et al in his experience with more than 1000 biopsy samples, he discovered that there were not side-effects or complaints. Healing in those cases was usually complete within one week, and barely visible scar usually remains. [18] Biopsy can be performed in hairy skin to investigate unmyelinated and thinly myelinated fibers and in glabrous skin to examine large

One further advantage of skin biopsy over conventional nerve biopsy is that it allows somatic nerve fibers to be distinguished from autonomic nerve fibers. Morphological changes, axonal degeneration and abnormal regeneration occur in cutaneous nerves very early in the course of peripheral neuropathies, making skin biopsy a promising tool to investigate the progression of neuropathy and the effect of neuroprotective treatments in clinical practice and trials.[19]

The neuropathies in which the skin biopsy is useful are diabetic neuropathy [18], demyelinat‐ ing neuropathies like Charcot-Marie-Tooth disease. [20][21], neuropathy associated with systemic diseases including sarcoidosis, systemic lupus erythematosus, Sjögren's syndrome, celiac disease, and Friedreich's ataxia and Fabry's disease. [22][23][24][25]. Infectious and inflammatory neuropathies like leprosy, HIV-associated sensory neuropathy, Churg Strauss

In diabetic neuropathy, skin biopsy is the most sensitive measureof a charge in the severity of neuropathy. [18] Monitoring method is an useful to track the progression of neuropathy in trials of neuroprotective treatments. In case of using skin biopsy to monitor progression or evaluate the effect of neuroprotective treatments; it should be repeated close to the site of a previous biopsy, within the territory of the same sensory nerve [19]Another use of blind skin

found, the biopsy ended up being therapeutic without being this its first target. [17]

be done in other regions of the body (eg. Face, trunk, or fingers). [18]

treatment.

8 Skin Biopsy - Diagnosis and Treatment

myelinated fibers. [19]

syndrome. [26][27].

In our search for information on the most suitable biopsy sites and stage of disease for optimal pathologic diagnosis, we did not find any article devoted entirely to this subject. Only sketchy information was available. Skin biopsy is an accessible tool, easy to perform, inexpensive, relatively safe and allows us to access the histopathological examination of the skin in all its depth, all layers, and microbiological studies or immunofluorescence or immunohistochem‐ istry can be made from it. This diagnostic method is for the dermatologist what the blood test is for the clinicians. Notably, its basic use, the most important and widely disseminated is in the diagnosis of various skin diseases, but it can also be used in monitoring and therapeutic evaluation of these diseases. For its easy carrying and accessibility, its application has been described in the diagnosis of non-dermatological diseases such as peripheral neuropathy, innovative application, which is deployed on multiple research studies, and offers a less invasive and easy –to-perform tool for the diagnosis of this pathology.

[11] Bichakjian, C, Halpern, A, et al. Guidelines of care for the management of primary cutaneous melanoma. Journal American Academy of Dermatology (2011). , 65(5),

Site Selection

11

http://dx.doi.org/10.5772/55638

[12] Pflugfelder, A, Weide, B, et al. Incisional biopsy and melanoma prognosis: facts and

[13] Somech, S, Taira, J, et al. Pigmented lesions in actinically damaged skin. Histopatho‐ logic comparison of biopsy and excisional specimens. Archives of Dermatology

[14] Connor, O, & Dzwierzynski, E. W. Longitudinal melonychia, clinical evaluation and biopsy technique. Journal Hand Surgery American (2011). , 36(11), 1852-4.

[15] Rajaratnam, R, Smith, A, et al. The value of skin biopsy in inflammatory dermatoses.

[16] Nicolis, G, & Helwig, E. Exfoliative dermatitis: a clinicopathological study of 135 pa‐

[18] Sommer, C, & Lauria, G. Skin biopsy in the management of peripheral neuropathy.

[19] Lauria, G, & Devigili, G. Skin biopsy as a diagnostic tool in peripheral neuropathy.

[20] Bai, J, Ghandour, K, et al. Skin biopsies in myelin-related neuropathies: bringing mo‐

[21] Sabet, A, Ghandour, K, et al. Skin biopsies demonstrate MPZ splicing abnormalities

[22] Nolano, M, Provitera, V, et al. Small fibers involvement in Friedreich's ataxia. Annals

[23] Hoitsma, E, Marziniak, M, et al. Small fibre neuropathy in sarcoidosis. Lancet

[24] Goransson, L, Herigstad, A, et al. Peripheral neuropathy in primary Sjögren's syn‐ drome: a population-based study. Archives of Dermatology (2006). , 63-1612.

[25] Scott, L, Griffin, J, et al. Quantitative analysis of epidermal innervatrion in Fabry dis‐

[26] Herrmann, D, Mcdermott, M, et al. Epidermal nerve fiber density, axonal swellings and QST as predictors of HIV distal sensory neuropathy. Muscle Nerve (2004). ,

in Charcot-Marie- Tooth neuropathy 1B. Neurology (2006). , 67-1141.

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