Dermatopathologists have noted an increased number of smaller biopsy specimens. Our objective was to determine whether dermatologists are changing their choice of biopsy technique and the size of biopsy specimens. We conducted a retrospective study of 500 biopsies performed by dermatologists for the purpose of diagnosis in 1988, 1993, 1998, and 2003. Our study results indicate that dermatologists are performing fewer punch biopsies and more shave biopsies. What’s more, there has been a decrease in the size of shave biopsy specimens. We believe that the decreased number of punch biopsies being performed combined with the decreased size of shave biopsy specimens may affect patient care. Cutis. 2005;76:335-339. Askin biopsy may be performed for either therapeutic reasons or to aid in the diagnosis of cutaneous diseases. Edward Keyes1 adapted the punch biopsy technique in 1887. During the 1930s, Buhmann2 first used the shave biopsy method to acquire cutaneous samples for epidermal metabolism research; this technique was not popularized for clinical use until 1974, when Kopf and Popkin3 advocated its use. In 1995, the shave biopsy technique was modified by the introduction of a flexible, disposable, “adaptor-designed” instrument that replaced the traditional scalpel or razor blade.4 Due to the dynamic nature of dermatology, we wanted to evaluate trends in the dermatologists’ choice of biopsy technique and the size of the resultant biopsy specimen. Materials and Methods A retrospective review of pathology reports was conducted at the Pennsylvania State Milton S. Hershey Medical Center, with approval by the institutional review board. Using the CoPathPlus® Anatomic Pathology database and archived pathology data, we analyzed 500 pathology reports of randomly selected skin biopsies performed by academic and private practice dermatologists in 1988, 1993, 1998, and 2003. Both punch and shave biopsy specimens were included in the study; excisional specimens were excluded, as were punch and shave biopsies that were performed for therapeutic rather than diagnostic intent (eg, biopsies performed to remove indubitable seborrheic keratoses, typical nevi, or acrochordons). A total of 500 pathology reports—125 consecutive biopsies from each of the 4 study years—were analyzed. Data were recorded regarding the year each biopsy was performed, each specimen’s location on the body (ie, head, extremities, trunk, genitalia), and each patient’s gender and age. Data also were compiled regarding the diagnostic clinical impression of the dermatologist, the final diagnosis of the dermatopathologist, and the type of biopsy (punch or shave). For punch biopsy specimens, we recorded the punch diameter as it was described in the pathology report. For shave biopsy specimens, the volume was calculated and recorded based on the dimensions described in the gross description in the pathology report. Comparisons were made among each of the 4 study years regarding type of biopsy performed, specimen size, specimen location on the body, and patient gender and age. Due to the presence of outliers when analyzing the size of the shave biopsy specimens, a trimmed mean was The Vanishing Biopsy: The Trend Toward Smaller Specimens Emmy M. Fernandez, MD; Thomas Helm, MD; Michael Ioffreda, MD; Klaus F. Helm, MD Accepted for publication March 1, 2005. Drs. Fernandez, Ioffreda, and K.F. Helm are from Pennsylvania State Milton S. Hershey Medical Center, Hershey. Dr. T. Helm is from the State University of New York at Buffalo. The authors report no conflict of interest. Reprints: Klaus F. Helm, MD, Pennsylvania State Milton S. Hershey Medical Center, 500 University Dr, Hershey, PA 17033 (e-mail: khelm@psu.edu). 336 CUTIS® Therapeutics for the