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OBJECTIVE:To review three commonly performed skin biopsy procedures: shave, punch, and excision.DATA SOURCES: English-language articles identified through a MEDLINE search (1966-1997) using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and cross-references. STUDY SELECTION:Articles that reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care. DATA EXTRACTION:Information was manually extracted from all selected articles and texts; emphasis was placed on information relevant to internal medicine physicians who want to learn skin biopsy techniques. DATA SYNTHESIS:Shave biopsies require the least experience and time but are limited to superficial, nonpigmented lesions. Punch biopsies are simple to perform, have few complications, and if small, can heal without suturing. Closing the wound with unbraided nylon on a C-17 needle will enhance the cosmetic result but requires more expertise and time. Elliptical excisions are ideal for removing large or deep lesions, provide abundant material for many studies, and can be curative for a number of conditions, but require the greatest amount of time, expertise, and office resources. Elliptical excisions can be closed with unbraided nylon using a CE-3 or FS-3 needle in thick skin or a P-3 needle on the face. All specimens should be submitted in a labeled container with a brief clinical description and working diagnosis. CONCLUSIONS:Skin biopsies are an essential technique in the management of skin diseases and can enhance the dermatologic care rendered by internists.KEY WORDS: skin biopsy; shave biopsy; punch biopsy; excision biopsy; internists. J GEN INTERN MED 1998;13:46-54. The skin biopsy is a relatively simple, but essential procedure in the management of skin disorders. Properly performed, it may confirm a diagnosis, remove cosmetically unacceptable lesions, and provide definitive treatment for a number of skin conditions. Skin biopsies are unique because the lesion can be visualized, allowing for proper selection of biopsy site and technique. Skin biopsies can be performed with minimal risk in critically ill patients, and a timely skin biopsy may avoid other, more invasive procedures.Skin biopsies are infrequently performed by internists. 1 This may reflect lack of proficiency, or uncertainty regarding indications, choice of procedure, specimen handling, or subsequent wound care. The purpose of this review is to discuss in detail the three most commonly performed biopsy procedures: shave, punch, and excision. METHODSEnglish-language articles identified through a MED-LINE search using the MeSH headings skin and biopsy, major dermatology and primary care textbooks, and selected cross-references were reviewed. Articles were selected if they reviewed the indications, contraindications, choice of procedure, surgical technique, specimen handling, and wound care and were relevant to internal medicine physicians wishing to learn skin biopsy techniques. BEFORE BIOPSY IndicationsIt...

Main objectiveTo evaluate the distribution of central corneal thickness (CCT) in a large German cohort and to analyse its relationship with intraocular pressure and further ocular factors.DesignPopulation-based, prospective, cohort study.MethodsThe Gutenberg Health Study (GHS) cohort included 4,698 eligible enrollees of 5,000 subjects (age range 35–74 years) who participated in the survey from 2007 to 2008. All participants underwent an ophthalmological examination including slitlamp biomicroscopy, intraocular pressure measurement, central corneal thickness measurement, fundus examination, and were given a questionnaire regarding glaucoma history. Furthermore, all subjects underwent fundus photography and visual field testing using frequency doubling perimetry.ResultsMean CCT was 557.3±34.3 µm (male) and 551.6±35.2 µm in female subjects (Mean CCT from right and left eyes). Younger male participants (35–44 years) presented slightly thicker CCT than those older. We noted a significant CCT difference of 4 µm between right and left eyes, but a high correlation between eyes (Wilcoxon test for related samples: p<0.0001). Univariable linear regression stratified by gender showed that IOP was correlated with CCT (p<0.0001). A 10 µm increase in CCT led to an increase in IOP between 0.35–0.38 mm Hg, depending on the eye and gender. Multivariable linear regression analysis revealed correlations between gender, spherical equivalent (right eyes), and CCT (p<.0001 and p = 0.03, respectively).ConclusionsWe observed positive correlations between CCT and IOP and gender. CCT was not correlated with age, contact lens wear, positive family history for glaucoma, lens status, or iris colour.