The diagnosis and type classification of Hansen's disease (HD) is dependent on a biopsy.  Several important factors should be considered before performing a skin biopsy in order to benefit the tissue sample and the pathologist.

A proper site is the single most important factor in the skin biopsy to be evaluated for HD.  The pathologist will be unable to make a definite diagnosis if bacilli cannot be demonstrated by means of the biopsy.  A general rule is that the biopsy should be taken entirely within the lesion, preferably from the active margin if there is one; this is especially important in the non-lepromatous forms of HD.  There is no necessity to include any normal tissue in the biopsy.  Where several different lesions exist, it is best to biopsy all lesions.  When no definite lesion can be found, the site for biopsy should be guided by information from skin scrapings and clinical findings such as decreased sensation and decreased sweating.

The biopsy should be made with a biopsy punch or by surgical excision.  In all instances, the biopsy should be deep enough to include subcutaneous fat; this depth of biopsy is very important, for often the most prominently involved nerves will be found in the upper portion of the subcutaneous tissue.  A 4 mm or larger biopsy punch should be used.  Surgical excision is made with a cold knife; removal of specimens by cautery is to be entirely avoided.  A proper fixative should be employed for specimen fixation and transfer; 10% neutral buffered formalin is used routinely.  At least five volumes of fixative per volume of tissue should be used.

Finally, adequate clinical information should always be submitted with the specimen.  The site of the biopsy should always be stated.  The attached diagram is helpful.  Relevant information includes:  number of lesions, changes in sensation, previous diagnoses and present clinical impressions, patient name, date of birth, sex, race, and social security number if available.

Consideration of the above factors will ensure a better interpretation by the histopathologist.

For histopathological consultation, at no charge, mail specimens in 10% neutral buffered formalin to:

or contact Dr. David Scollard, Chief, Pathology Research Department at (225) 578-9841 or  dscoll1@lsu.edu.

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