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National Hansen's Disease Program

 

Skin Biopsy in the Diagnosis of Hansen's Disease

Skin Biopsy Protocol for Diagnosis and Follow-up of Hansen’s Disease

 

Indications for biopsy:

  • Possibility of Hansen’s Disease, including:  Long-standing skin lesions, not responding to conventional topical treatments, skin lesions in persons with history of travel/ residence in developing country

Biopsy:

  • Select the most active margin of the most active lesion
  • Obtain a full-thickness biopsy – it is important to see a bit of subcutaneous fat.
  • Either elliptical or punch biopsy is OK (4 mm punch is sufficient)

Fixation and processing:

  • Routine 10% neutral buffered formalin
  • Send to NHDP in formalin OR embedded in paraffin by your pathology laboratory

Send to NHDP:

  • Biopsy in formalin OR paraffin block OR  2-3 unstained slides
  • Documentation:  basic patient information and clinical questions, including DOB or age.  Patient treated?  If yes, how long?  Use of steroids?
  • What is the question you want to ask the pathologist?
  • Please include a biopsy report from your lab if examined there
  • Send by mail or courier, as you like.

Address:
            Clinical Laboratory
National Hansen’s Disease Programs
            1770 Physician Park Dr.
            Baton Rouge, LA 70816
            Tel 225-756-3733

 

 

If you have questions or require further information, contact:

David M. Scollard, M.D., Ph.D.
Acting Chief, Clinical Branch
National Hansen's Disease Programs
1770 Physician Park Dr.
Baton Rouge, LA 70816
tel:  225-756-3713
FAX: 225-756-3819
dscollard@hrsa.gov
www.hrsa.gov/hansens

 

Protocol for Submitting Speciments for Histological Evaluation of Hansen's Disease

The following are the requirements needed before sending a biopsy for routine histological evaluation:

  1. A biopsy collected with a 4 – 5 mm punch (2 mm if on face) or surgical excision, which should be deep enough to include subcutaneous fat. This depth is important because often the most prominently involved nerves will be found in the upper portion of the subcutaneous fat. As a general rule, the biopsy should be taken entirely within the lesion, preferably from the active margin if there is one.
  2. Place in 10% buffered formalin, at least 5 volumes of fixative per volume of tissue. Label container with patient’s name and biopsy site.
  3. A brief clinical history including number of lesions, changes in sensation, previous diagnosis and present clinical impressions.
  4. The patient’s name, sex, race and social security number if available.
  5. The patient’s date of birth.
  6. The submitting doctor’s name and the address where the report is to be sent.
  7. Send biopsy in leak-proof container.


The following specimens may also be submitted for evaluation (listed in order of preference):

  1. Paraffin blocks.
  2. Slides of unstained sections - preferably at least 4 slides.
  3. Stained slides to include H&E and Fite.

Specimens should be placed in protected mailing containers to prevent damage such as screw-cap cardboard cylinders or padded mailing envelopes.


Specimens are then sent to:
National Hansen’s Disease Programs
Clinical Lab
1770 Physicians Park Drive
Baton Rouge, LA 70816
Att: George Reed or Steve Keas