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A punch biopsy is essentially an incisional biopsy, except it is round rather than elliptical as in most incisional biopsies done with a scalpel. Incisional biopsies can include the whole lesion (excisional), part of a lesion, or part of the affected skin plus part of the normal skin (to show the interface between normal and abnormal skin).
The biopsy material is then sent to a laboratory to be evaluated by a pathologist. A skin biopsy can be a punch, shave, or complete excision. The complete excision is the preferred method, but a punch biopsy can suffice if the patient has cosmetic concerns (i.e. the patient does not want a scar) and the lesion is small.
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Photomicrographs of a punch biopsy from a Buruli ulcer plaque lesion. In the left image, the tissue sample has been stained with hematoxylin and eosin, a common stain for histopathology examination. In the right image, it has been stained with Ziehl–Neelsen stain, which helps to visualize mycobacteria.
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Micrograph showing necrobiosis lipoidica in a punch biopsy NL is diagnosed by a skin biopsy, demonstrating superficial and deep perivascular and interstitial mixed inflammatory cell infiltrate (including lymphocytes, plasma cells, mononucleated and multinucleated histiocytes, and eosinophils) in the dermis and subcutis, as well as necrotising ...
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Histological sections were stained either with Haematoxylin-Eosin (HE) (A, C–E), Ziehl-Neelsen (counterstain methylenblue) (ZN) (B) .. A: Punch biopsy with large necrotic areas, fat cell ghosts and oedema but relatively intact epidermis and dermis. B: a band of extracellular AFBs is present in a deep layer of the necrotic subcutis."