What type of doctor normally performs a scalp biopsy?

What type of doctor normally performs a scalp biopsy? How do I get a scalp biopsy?

I’m often asked what type of doctor someone with hair loss should see if they think they need a scalp biopsy. The formal answer to this question is that a biopsy can really be performed by any type of doctor that meets all of the following criteria:

1. The practitioner has the skills to perform a 4 mm punch biopsy and know how to store the sample and what lab to send it to

2. The practitioner knows where on the scalp the biopsy should best be taken and what areas are probably not as useful.

A biopsy, in my opinion, should not be done by a practitioner who:

1. is not knowledgeable about the proper techniques of punch biopsies

2. is not really sure where to take the sample from (and therefore just chooses a random spot on the scalp).

So who usually meets this criteria?

Most scalp biopsies are performed by dermatologists. However, a variety of other physicians may have the knowledge and skills to perform a biopsy as well. These include hair transplant doctors, general practitioners, family doctors, internists, plastic surgeons and in some jurisdictions- nurse practitioners too. Dermatologists most commonly are the type of physician that does scalp biopsies.

If I want a biopsy, can I just ask for one?

The short answer is sure - if a patient wants a biopsy go ahead and ask for one. At least make your concerns known! However, my strong view is that a biopsy should never be done just because a patient wants it done. Many are surprised to hear this - but that’s where problems arise. A biopsy should be done whenever the diagnosis is still not certain after reviewing the patient’s history, examining the scalp and reviewing blood test results. 

I usually respond to the question about who a patient should see for a biopsy by first saying that not everyone with hair loss needs a scalp biopsy and not every scalp biopsy is 100 % accurate. It’s true that a scalp biopsy can often be a tremendous help in the diagnosis of hair loss -  but not without the three other key clues (namely the clinical history, the examination findings and the blood test results).

When a person who is not my patient emails my office and asks our team “Can you ask Dr Donovan what he thinks of my biopsy results? I’m going to attach them here.” I can only reply to that person by saying that unfortunately without the key three clues (ie the clinical history, the examination findings and the blood test results) a biopsy can not (or should not) be fully interpreted. In other words, if I don’t know all the patient’s details, interpretation of a biopsy must be done with extreme caution.

Biopsies are wonderful tools in the right situation and at the right time. If a patient is going to have a biopsy it must be done by a physician who says “I’ve done these sorts of procedures many times before and I think this spot right here on the scalp is the very very best place to take your biopsy.”