Getting to the Root of Hair Loss
Most of the time when you hear the word “biopsy,” your mind immediately shifts to the possibility of cancer. While this is probably the most common context in which you hear this word, the biopsy process is used in dermatology to diagnose skin conditions that have nothing to do with cancer.
Dermatologists use this procedure every day, using local anesthetic to numb the skin and a variety of techniques to remove tissue for further examination. A series of steps take place to give your physician the diagnostic results related to hair loss:
• Informed consent about the procedure
• Collection of the tissue specimen from the area of hair loss
• Insertion of the tissue specimen into a preservative
• Processing of the tissue by a dermatopathology lab
• Diagnostic report issued from the dermatopathology
lab to the physician who collected the biopsy specimen
You will usually be provided with a consent form that explains the biopsy procedure that is planned as well as the diagnostic reason that you are having it done. The consent form will also explain any medical risks associated with the procedure, such as bleeding or infection.
Collection of the Tissue Specimen and Insertion of the Tissue into a Preservative
The biopsy procedure itself involves collecting a tissue sample that is transferred to a preservative. First, the area to be biopsied is marked off with a surgical marker, and a local anesthetic compound is administered by injection. After time is allowed for the anesthetic to take effect, the tissue is removed from the area of hair loss using a dermal punch that allows a small cylinder of skin from the outer layer down to the subcutaneous fat.
The tissue sample is then removed and placed into the container with the preservative. Next, the open area is closed by stitching the skin edges back together.
The skin sample from the scalp that has been collected in the biopsy bottle is then put together with a requisition form with identifying information of who the specimen belongs to as well as brief information about the medical history, physical findings, and diagnostic possibilities the clinician is considering.
Processing of the Tissue by a Dermatopathology Lab
The biopsy specimen is subsequently delivered to a specialty lab for evaluation by a physician who specializes in reading and interpreting tissue samples related to dermatology. These physicians, dermatopathologists, get special board certification separate from certification obtained by clinical dermatologists.
In the lab, the tissue samples are fixed in a block of paraffin. Then, very thin slices of tissue are aligned onto microscope slides, which are then provided to the dermatopathologist physician to read.
Once the slides are read, a written report is prepared based upon the
findings present. The report is delivered back to the original physician
who performed the biopsy.
On some occasions, special stains may be necessary, requiring a new set of slides to be prepared, enabling a more accurate diagnosis to be made.
Dermatopathology Report Received by Original Dermatologist
A biopsy report is usually received back two to five days after the surgical procedure. On some occasions, seven to fourteen days might be required if special stains have to be done. The following is an example of the information I would get back if you were to have a biopsy of your scalp
Diagnosis: Scalp Alopecia, Scarring Central Centrifugal,
Consistent With Microscopic Description
Fibrosis of follicular structures with formation of fibrous tracts and chronic inflammation are seen. Sebaceous glands in remaining follicles are not inflamed, and no infundibular fibrosis is seen. Central centrifugal alopecia could be considered mostly by exclusion of the other possibilities. No specific changes are seen in seventeen sections examined.
Once the report is back, your dermatologist will review your results with you. Based upon the results obtained and the diagnosis explained, a treatment plan will be determined.
These are the sequence of steps involved in evaluating a biopsy of the scalp for a variety of hair loss conditions such as discoid lupus, lichen Planopilaris, and many more.
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