Skip Navigation HRSA - U.S Department of Health and Human Services, Health Resources and Service Administration U.S. Department of Health & Human Services
Home
Questions
Order Publications
 
Grants Find Help Service Delivery Data Health Care Concerns About HRSA

National Hansen's Disease Program

 

Skin Biopsy in the Diagnosis of Hansen's Disease

The diagnosis and type classification of Hansen's disease (HD) is dependent on a biopsy.  Several important factors should be considered before performing a skin biopsy in order to benefit the tissue sample and the pathologist.

A proper site is the single most important factor in the skin biopsy to be evaluated for HD.  The pathologist will be unable to make a definite diagnosis if bacilli cannot be demonstrated by means of the biopsy.  A general rule is that the biopsy should be taken entirely within the lesion, preferably from the active margin if there is one; this is especially important in the non-lepromatous forms of HD.  There is no necessity to include any normal tissue in the biopsy.  Where several different lesions exist, it is best to biopsy all lesions.  When no definite lesion can be found, the site for biopsy should be guided by information from skin scrapings and clinical findings such as decreased sensation and decreased sweating.

The biopsy should be made with a biopsy punch or by surgical excision.  In all instances, the biopsy should be deep enough to include subcutaneous fat; this depth of biopsy is very important, for often the most prominently involved nerves will be found in the upper portion of the subcutaneous tissue.  A 4 mm or larger biopsy punch should be used.  Surgical excision is made with a cold knife; removal of specimens by cautery is to be entirely avoided.  A proper fixative should be employed for specimen fixation and transfer; 10% neutral buffered formalin is used routinely.  At least five volumes of fixative per volume of tissue should be used.

Finally, adequate clinical information should always be submitted with the specimen.  The site of the biopsy should always be stated; a chart for this purpose is linked from the top of this page.  Relevant information includes:  number of lesions, changes in sensation, previous diagnoses and present clinical impressions, patient name, date of birth, sex, race, and social security number if available.

Consideration of the above factors will ensure a better interpretation by the histopathologist.

For histopathological consultation, at no charge, mail specimens in 10% neutral buffered formalin to:

National Hansen's Disease Programs
Attention: Clinical Lab
1770 Physicians Park Drive
Baton Rouge, La.   70816

or contact Dr. David Scollard, Chief, Pathology Research Department at (225) 578-9841 or dscoll1@lsu.edu.

Protocol for Submitting Speciments for Histological Evaluation of Hansen's Disease

The following are the requirements needed before sending a biopsy for routine histological evaluation:

  1. A biopsy collected with a 4 – 5 mm punch (2 mm if on face) or surgical excision, which should be deep enough to include subcutaneous fat. This depth is important because often the most prominently involved nerves will be found in the upper portion of the subcutaneous fat. As a general rule, the biopsy should be taken entirely within the lesion, preferably from the active margin if there is one.
  2. Place in 10% buffered formalin, at least 5 volumes of fixative per volume of tissue. Label container with patient’s name and biopsy site.
  3. A brief clinical history including number of lesions, changes in sensation, previous diagnosis and present clinical impressions.
  4. The patient’s name, sex, race and social security number if available.
  5. The patient’s date of birth.
  6. The submitting doctor’s name and the address where the report is to be sent.
  7. Send biopsy in leak-proof container.


The following specimens may also be submitted for evaluation (listed in order of preference):

  1. Paraffin blocks.
  2. Slides of unstained sections - preferably at least 4 slides.
  3. Stained slides to include H&E and Fite.

Specimens should be placed in protected mailing containers to prevent damage such as screw-cap cardboard cylinders or padded mailing envelopes.


Specimens are then sent to:
National Hansen’s Disease Programs
Clinical Lab
1770 Physicians Park Drive
Baton Rouge, LA 70816
Att: George Reed or Steve Keas