FAQ for Dermatopathology:

Does your laboratory perform direct imunofluorescence procedure for skin biopsies? 
Direct immunofluorescence procedures (DIF) for skin biopsies are performed in our laboratory (IgA, IgG, IgM, C3).


What are the requirements for transportation of material for DIF testing?

For skin biopsy testing laboratory should receive two samples – one from the fresh lesion fixed in formalin, other unfixed for IF diagnostics (in special medium "Michel's Transport Medium" or frozen in liquid nitrogen with dry ice). If the transportation time is less than 24 hours, specimen could be transferred in a saline solution. In this case, specimen should be put into container with saline and then this container should be put into another container with ice (+4C). 

Could you recommend the best selection of biopsy site for IF?

a. Pemphigus and pemphigoid groups (including linear IgA bullous dermatosis and chronic bullous disease of childhood): Biopsy erythematous perilesional skin or mucosa. Avoid center of erosions, ulcers, and bullae while obtaining tissue adjacent to active lesions. Label as perilesional skin.

b. Dermatitis herpetiformis: Biopsy normal-appearing skin, 0.5 to 1 cm away from lesion. Label as perilesional skin.

c. Lupus erythematosus: Involved areas of skin such as erythematous or active borders are preferred biopsy sites to confirm diagnosis of lupus erythematosus, either discoid or systemic. Label as involved skin. Uninvolved, nonexposed skin is the preferred site to exclude systemic lupus erythematosus. Should unexposed skin be desired, buttock or medial thigh is suggested. Label as uninvolved, nonexposed skin. Avoid ulcers, old lesions, and facial lesions, if possible.

d. Mixed connective tissue disease: Biopsy as for lupus erythematosus except when sclerodermoid features are present. For sclerodermoid features, biopsy inflamed area. Label as involved or uninvolved, exposed or nonexposed skin.

e. Vasculitis and urticaria: The erythematous or active border of a new lesion is preferred. Avoid old lesions and ulcers.

Label as involved skin. If appropriate skin lesion is not present, diagnosis may sometimes be made from uninvolved skin. f. Porphyria cutanea tarda: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin.

g. Lichen planus: Biopsy involved skin. Avoid old lesions and ulcers. Label as involved skin.

Specimens for light microscopy:

Specimen should show an intact vesicle or bulla if possible (from fresh lesion (not an excoriation or the crust, ulceration). If small vesicles are present, removal of an entire lesion is preferred. For larger lesions, the specimen should be obtained from the edge of a blister and should contain both portions of the blister and intact skin so that the edge of the blister and inflammatory infiltrate can be seen.

What is the price for the procedure?
Skin biopsy (one object/sample) costs 36,5 Eur, each IF stain – 10 Eur (usually are performed 4 for the case: IgA, IgG, IgM, C3). Full price list is http://www.vpc.lt/price-list.html .

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