Biopsies are routinely done at the lateral calf (10 cm above the lateral malleolus) and lateral thigh (at the level of a pubis). The calf is more commonly affected in distal symmetric neuropathy, but the thigh may be selectively affected in ganglioneuritis or multifocal neuropathy. Procedure  Make a 1 cm circle around the biopsy site. Clean the skin with an alcohol swab and anesthetize the skin by injecting a 2% lidocaine with epinephrine solution along the edge of the circle while making sure to infiltrate but avoid direct contact with the biopsy site.  Perform the biopsy using a 3 mm disposable circular punch at a depth of approximately 2 mm, or half the distance of the metal head.  Lift the edge of the biopsy with anesthetizing needle and free it from the attached underlying fatty tissue using forceps and a scissor. Forceps should never contact the upper layer of the skin, but only the underlying tissue, as they might destroy the nerve fibers.  Place the biopsy section into the vial with the cold fixative, label the vial with the patient name and social security number, and identify the site of the sample on the requistion sheet. Mail the sample to Therapath in the overnight shipping kit with the prepaid air bill.
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Skin Biopsy Procedure
