EXPERT ANALYSIS FROM THE AAD SUMMER ACADEMY 2016
BOSTON (FRONTLINE MEDICAL NEWS) – Most ulcers seen in the clinic setting are venous, arterial, or neuropathic, but about 10% are tied to “more unusual causes” and require biopsy, according to Tania J. Phillips, MD.
A particular concern is malignancy, Dr. Phillips, professor of dermatology at Boston University, said at the American Academy of Dermatology summer meeting.
“We do need to have a low threshold for biopsying wounds – particularly if they are wounds of long duration and are not healing,”
A rule of thumb for performing biopsy is 3 months of non-healing, she said.
“If you have a non-healing wound and you’re doing good wound care, you have to re-evaluate. Do you have the right diagnosis? You may need several biopsies on several different occasions to get the right diagnosis,” she said.
Other reasons to biopsy include suspected infection – whether bacterial, fungal, or mycobacterial; atypical appearance; suspected vasculitis; and recent travel history.
Ideally, the biopsy will include a deep wedge containing wound margin and the wound bed.
“Failing that, [take] multiple punch biopsies from the wound bed and the margins,” she said.
While many people are nervous about biopsying an ulcer, most biopsy sites heal very well with no complications, she noted.
As for what to do with the tissue, it can be sent in formalin.
“But if you’re going to do immunofluorescence, you will need Michel’s medium. And if you want to culture, just check with your microbiology lab, because often they will take your piece of tissue and they’ll mix it up, and they’ll divide it and will send it out for bacterial, fungal, mycobacterial culture and you won’t have to do that yourself,” she said.
Dr. Phillips noted that she doesn’t usually suture an ulcer biopsy site.
“The skin around ulcers is usually very friable, the sutures often pull out, and you can usually just pack the biopsy site with gel foam or with an alginate, and then just apply firm compression like a wrap over the biopsy site and you’ll do just fine,” she said.
Dr. Phillips reported a financial relationship with Hygeia.
