In 2014, Endo, et al. reported successful retention of intact epithelium in 51 of 52 lesional, perilesional or distant DG biopsy sites (98.1%), and the pathologic diagnosis was confirmed in all 52 tissue samples.31 They termed their method the stab-and-roll technique which is designed to avoid lateral shearing forces likely to disrupt epithelial integrity by uniformly directing the cutting forces internally to bone. In the stab motion, the tip of a #15 scalpel blade is gently inserted to bone while in the roll motion the blade is rolled from the tip along its full cutting edge, thereby applying only an internally directed force. If more tissue is required, the tip is again inserted into the incision line and the rolling stroke is repeated. The soft tissue is gently undermined with a scalpel and removed with a non-serrated small tissue forceps. No controls were used in this study but comparison between the stab-and-roll successful results (98.1%) versus other reported techniques (58.8-60.0%) suggests a significant improvement.85,87
Whatever biopsy technique was chosen, it is extremely important the specimen be appropriately transported to the pathologic or immunofluorescence laboratory. Tissue for histopathology examination is transported in formalin. However, tissue placed in formalin cannot be evaluated by DIF. Instead the DIF specimen can be quick-frozen in liquid nitrogen and immediately transported in that fashion, but most often it is transported in a special transport medium (Michel’s transport medium).14,7 Most laboratories that perform immunofluorescence will provide the transport medium free of charge.