PA19 The importance of a paediatric biopsy service in dermatology departments: a service evaluation

Access to paediatric skin biopsy services in dermatology departments varies widely. A timely skin biopsy can result in a quicker diagnosis for the family and child and hence swifter management, which is crucial for a paediatric dermatology service to run efficiently. Some services may be reliant upon assistance from other specialists, such as the plastic surgeon, to perform these procedures, which are sometimes preformed unnecessarily under a general anaesthetic. This can complicate the patient pathway, resulting in breaks in continuity of care and delays to investigations. Overall, there is a paucity of published data on skin biopsies in children, particularly on the indications and spectrum of diagnoses. We performed a service evaluation of our paediatric biopsy service at a busy district general hospital, to understand the role and importance of this service. We have a total of four paediatric dermatologists, who have regular clinics and theatre lists. We collected data retrospectively on paediatric biopsies performed between April 2020 and March 2023 (a 35-month period). Nearly all patients attending for a biopsy had clinical images taken. In total 71 biopsies were performed on children during this timeframe. Most patients were aged between 11 and 15 years (61%), with 7% aged 16–18 years, and the remainder aged < 10 years (32%). There was an even sex distribution, with 35 male patients and 36 female patients. A variety of procedures were performed, with punch biopsies (30%) and excision biopsies (24%) being the most common type. Regarding the body site, 17% of procedures were performed on the head and neck, and 8% on the scalp. In total, 41% were performed on the limbs, and 32% on the torso or abdomen. The biopsies were categorized as lesional or inflammatory. Forty-six biopsies (65%) were performed for lesions, of which pyogenic granuloma was the most common cause (15%), alongside spitz naevus (11%). Twenty-five biopsies (35%) were performed for inflammatory conditions, including folliculitis decalvans (1%), ichthyosis (1%), lymphangioma circumscriptum (1%) and confluent and reticulated papillomatosis (1%), alongside many other pathologies. Of lesional biopsies, 37 (80%) had the correct diagnosis listed prior to the procedure and 9 (20%) were incorrect. Of the inflammatory pathologies, 17 (68%) were correct, and 8 (32%) incorrect. This demonstrates the importance of the biopsy in identifying the diagnosis. Our data demonstrate the importance of a paediatric dermatology biopsy service offered at all sites where paediatric dermatology is undertaken, to aid in the diagnosis and management of paediatric patients in a timely fashion.