Pathology · patient case question
Which biopsy is used for diagnosis?
Patient case: Desquamative gingivitis with positive Nikolsky sign
Scenario: Buccal mucosa PEELS on slight manipulation and the patient has a burning mouth after eating spicy food. There is GENERALISED DESQUAMATIVE GINGIVITIS on the facial gingiva (photo showed swollen, reddish gingiva). The description is effectively a POSITIVE NIKOLSKY SIGN.
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Correct answer: D. Perilesional biopsy
- A. Culture and sensitivity is for infectious disease, which this is not.
- B. Excising the ulcer bed removes exactly the epithelium that was already lost — the diagnostic information sits at the margin.
- C. Brush biopsy samples surface cells only and cannot demonstrate the level of epithelial separation or the immunofluorescence pattern.
- D. Correct. Vesiculobullous disease requires a PERILESIONAL biopsy — normal-appearing tissue immediately ADJACENT to the lesion — so that intact epithelium is present for direct immunofluorescence. Sampling the ulcer itself yields only denuded, non-diagnostic tissue.
Note: Send the perilesional specimen in Michel's medium for DIRECT IMMUNOFLUORESCENCE, and a second specimen in formalin for routine H&E.