Skin biopsy depth
 

I’m thinking whether to file a complaint against the doctor who did my skin biopsy. I wrote about it here a few months ago.

On my biopsy report it was written that the sample’s diameter was 4mm and length 8mm.
The biopsy included epidermal and dermal structures (fibers innervating blood vessels, sweat glands, arrector pili muscles, etc.).

According to the replies on that discussion the biopsy size should be only about 3x1mm.
Is it right even when the biopsy includes the dermal structures ?

I searched for papers about it and most of the guidelines that I found describes the location and diameter but not the depth.

In a paper by Lauria, et al. 2010 - European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy.
Is written –
“Skin biopsy is most commonly performed using a 3-mm disposable punch under sterile technique, after topical anesthesia with lidocaine. No suture is required. A shallow biopsy (3–4 mm) is adequate to study epidermal nerve fibers, whereas a deeper biopsy (6–8 mm) is required to include sweat glands, hair follicles, and artero-venous anastomosis.”
So is there any chance that 8mm depth is reasonable for this test after all ?
Thanks!

Well, if those are the guidelines, then I'm not sure you'd have much of a case. Mine, like the others from the US, was very shallow, 1-3 mm, but perhaps your physician was trying too get at "sweat glands, hair follicles, and artero-venous anastomosis", or would at least claim as much, if a complaint was filed.

I suppose if you could find some paperwork, evidence and such things that show the physician didn't check these other things, then you might have a case? But equally important would be to check the norms for the hospital or lab and the country or region.

I don't know what else to say. Perhaps someone else can be more helpful. :)

Thanks Davidת Your biopsy didn't include the innervation's of the sweat glands, hair follicles, etc. ?
My biopsy included ןא, I thought it was the standard when testing for SFN to check the autonomic innervation.
And from the replies I got on the previous thread I understood that my biopsy was too deep.

I don't know anyone in my area who did this test and I don't know which lab checked my sample and how to contact them.
When my neuro saw the scar that I had a few months after the biopsy he said it shouldn't look that way, but he didn't know what was supposed to be the depth of the wound.

I would be glad if anyone here who did the biopsy with the autonomic testing (innervation of the seat glands, hair follicles and blood vessels) could write the sample size that was taken.

Right, my biopsy was just a skin punch that didn't go very deep, and was just intended to count the nerve fibers. They didn't check for those other things for me, which doesn't seem to be the norm here. Perhaps someone else had the more thorough and deeper biopsy done and can speak to that. I wish I could be more helpful. :)

My biopsy results included sweat gland nerve fiber density - let me see if I can find the report! As I remember it it was not very deep and healed quickly but I will try to find the paperwork to support that.

Mine says 0.3 cm in diameter by 0.3 cm. That was on the sweat gland nerve fiber density results sheet. Let me know if you need any other info!

Sorry I must have misread - it has to be mm NOT cm!

Thanks for checking!
I guess the units are right, the diameter is supposed to be 3mm = 0.3cm

Oh my it is definitely monday. Yes it did say it in cm as 0.3. Sorry for the confusion. Not sure if the other things that you mentioned would cause a need for a deeper biopsy but sweat gland nerve fiber can be done with a standard depth.