For Physicians: Cutaneous Nerve Biopsy and Analysis

Physicians can schedule patients for cutaneous nerve skin biopsies at Johns Hopkins without a separate new patient consultation visit. Call 410-502-7930.

You can also perform skin punch biopsies in your office and send the tissue samples to our lab for processing and interpretation.

The process is simple. Here are step-by-step instructions:

  1. Submit patient information and order a kit
  2. Perform the biopsy
  3. Ship the biopsy
  4. Teach patient proper site care

Submit Patient Information and Request a Test Kit

To order a biopsy kit, please call 410-955-3254 or email [email protected]. The kit contains the following:

  • Tubes of Zambonis fixative
  • Requisition card to be completed
  • Quick reference card with biopsy and shipping instructions
  • Prepaid FEDEX clinical pack for return shipment
  • Patient care kit containing bandages and wound care instructions to give to patients
  • Physician kit containing:
    • 3mm punch biopsy tool
    • Suture removal kit
    • Biopsy tube labels
    • Gauze
    • Alcohol wipes
    • Bandages

Please note that the following supplies are NOT part of the kit, but will be needed to complete the skin biopsy:

  • Injectable local anesthetic
  • Syringe
  • Gloves
  • Tape measure
  • Skin marker

Performing the Biopsy

Standard biopsy sites are distal leg, distal thigh and proximal thigh. 

A cutaneous nerve/skin biopsy is a very simple procedure that takes 10 to 15 minutes and is performed in an outpatient setting.

  • The skin is thoroughly cleaned and a small injection of a local anesthetic to numb the skin is made.
  • A sample of skin is taken by a biopsy from the numb area of the skin.
  • A band-aid dressing is used to cover the biopsy site.

Generally, the skin heals easily within one to two weeks. The risk of bleeding or infection is extremely low.

Patients who are anticoagulated with INR > 2.5 should not have the biopsy.

Steps to Perform a Cutaneous Nerve/Skin Biopsy

Biopsy Shipping Instructions

Please follow the guidelines below for proper shipping instructions and related information.

  1. Do not ship specimens on Friday, Saturday, Sunday or the day before a major holiday. If in doubt, contact us at 410-502-7930.
  2. Place labeled specimen tubes in the leak-proof plastic bag provided with the shipping kit.
  3. Place the plastic bag into the brown kit box. Then put the brown box and completed requisition form into the FEDEX Clinical Pack with prepaid label.

Contact FEDEX for pickup. Our shipping address is:

Johns Hopkins Cutaneous Nerve Lab
ATTN: Kelly Wagner
The John G Rangos Bldg, Rm 440.11
855 N. Wolfe Street
Baltimore, MD 21205

Phone: 410-955-3254

Patient Instructions for Biopsy Site Care

  1. Leave your wound dressings in place for the rest of the day of the biopsy and keep them dry.
  2. Refrain from doing extremely strenuous activity for the rest of the day of your biopsy (such as running or heavy lifting).
  3. Change band-aids daily starting the day after the biopsy until there are no open wounds. This can take anywhere from 1 or 2 days up to 2 weeks (5-6 days is average for daily band-aid changes). 
  4. The wounds may or may not form a scab as they heal; either is fine.
  5. Showers are fine starting the day after the biopsy. Leave the band-aids in place while you shower and change them after you dry off.
  6. During the time period of daily band-aid changes, do not soak in a bath or swim.
  7. If you need to clean the wounds, you can use hydrogen peroxide. If the wounds are fine (no signs of infection), a daily band-aid change is all you need.
  8. The local anesthetic used for the biopsy will usually last for 1 to 2 hours after the procedure. After it wears off, you may have some mild localized soreness and tenderness at the biopsy sites over the next day or two. You may find regular Tylenol is helpful for the discomfort.
  9. Once the biopsy sites heal, they may look slightly red or darker than the rest of the skin. This discoloration will gradually fade and blend with your normal skin color. This fading process may take anywhere from a few months up to a year.
  10. Problems during the healing period are very rare. It is normal for the biopsy sites to bleed a little or drain pink fluid for a day or two after the procedure. They should not bleed excessively (i.e., through the band-aid) after that time. They should never drain pus. If you experience problems with significant bleeding, redness, infection or other problems, call your doctor's office.