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How to perform a skin biopsy

Kirsty JL Wark, Saxon D Smith and Deshan F Sebaratnam
Med J Aust 2020; 212 (4): . || doi: 10.5694/mja2.50473
Published online: 2 March 2020

The skin has more disease processes than any other organ system in medicine, with over 3000 dermatological conditions described.1 Teaching of dermatology is often neglected in medical training internationally, and most doctors feel ill‐equipped to diagnose cutaneous pathology.2 Compounding this, limitations in access to specialist dermatologists in Australia are well recognised.3 Fortunately, biopsy of the skin is a simple skill to learn which can greatly help with the diagnosis of dermatological diseases. For cutaneous malignancies, the diagnosis is principally based on histopathological findings. However, for rashes, the correlation between clinical and pathological findings is paramount. For instance, observation of a lichenoid reaction pattern on skin biopsy may reflect lichen planus, lupus, dermatomyositis, lichen sclerosus, cutaneous T cell lymphoma, or graft‐versus‐host disease. To maximise the diagnostic yield of a skin biopsy, an understanding of the different types of biopsy, their indications and limitations is vital (Box 1 and Box 2).


  • 1 Liverpool Hospital, Sydney, NSW
  • 2 Royal North Shore Hospital, Sydney, NSW
  • 3 University of Sydney, Sydney, NSW
  • 4 Sydney Children's Hospitals Network, Sydney, NSW


Correspondence: deshan@unsw.edu.au


Series editors

Balakrishnan (Kichu) Nair

Simon O'Connor


Acknowledgements: 

We thank Alicia O'Connor, Anes Yang, Victoria Venning, Imogen Faulds and our patients for their contributions to the clinical images.

Competing interests:

No relevant disclosures.

  • 1. Bickers DR, Lim HW, Margolis D, et al. The burden of skin diseases: 2004: a joint project of the American Academy of Dermatology Association and the Society for Investigative Dermatology. J Am Acad Dermatol 2006; 55: 490–500.
  • 2. Hussain W, Hafiji J, Stanley AG, Khan KM. Dermatology and junior doctors: an evaluation of education, perceptions and self‐assessed competencies. Br J Dermatol 2008; 159: 505–506.
  • 3. Sebaratnam DF, Murrell DF. Dermatology training and practice in Australia. Int J Dermatol 2014; 53: 1259–1264.
  • 4. de Menezes SL, Kelly JW, Wolfe R, et al. The increasing use of shave biopsy for diagnosing invasive melanoma in Australia. Med J Aust 2019; 211: 213–218. https://www.mja.com.au/journal/2019/211/5/increasing-use-shave-biopsy-diagnosing-invasive-melanoma-australia
  • 5. Elston DM, Stratman EJ, Miller SJ. Skin biopsy: biopsy issues in specific diseases. J Am Acad Dermatol 2016; 74: 1–16.

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