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Biopsies in several locations may be necessary2

  • All topical treatments (especially topical corticosteroids and systemic immunosuppressants) should be discontinued at least 2 to 4 weeks before performing a biopsy2
  • —Discontinuing topical treatments 2 to 4 weeks prior to performing the biopsy helps provide more accurate diagnoses2

Consider the type of lesion when evaluating which type of biopsy may be appropriate

  • A shave biopsy samples a broad area of the epidermis and is typically used for thin lesions3
  • For thicker lesions, a punch biopsy may be more fitting3
  • An identical clone at multiple sites is suggestive of MF-CTCL (more likely to be seen in patients with advanced disease, but can also be detected in patients with early disease of MF-CTCL)4
punchbiopsy
shavebiopsy

Follow-up biopsies of early lesions are preferable in doubtful cases of malignancy5

References:

  1. Referenced with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Primary Cutaneous Lymphomas V.2.2019. © National Comprehensive Cancer Network, Inc. 2018. All rights reserved. Accessed December 17, 2018. To view the most recent and complete version of the guideline, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.
  2. Pimpinelli N, Olsen EA, Santucci M, et al. Defining early mycosis fungoides. J Am Acad Dermatol. 2005;53:1053-1063.
  3. Pickett H. Shave and punch biopsy for skin lesions. Am Fam Physician. 2011;84(9):995-1002.
  4. Elston DM, Stratman EJ, Miller SJ. Skin biopsy: biopsy issues in specific diseases. J Am Acad Dermatol. 2016;74:1-16.
  5. Song SX, Willemze R, Swerdlow SH, Kinney MC, Said JW. Mycosis fungoides: report of the 2011 Society for Hematopathology/European Association for Haematopathology workshop. Am J Clin Pathol. 2013;139(4):466-490.