Is a biopsy from the side of my scalp a good idea?

Sites of a Scalp biopsy

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in biopsies for male androgenetic alopecia.

Question

Hi Dr. Donovan. I am a 28 year old male. I had a biopsy from side of my scalp and doctor said my diagnosis is androgenetic alopecia Is this a good place to take the biopsy? I have zero thinning from the crown!!

Answer

Well, I would need to see the scalp and know more about your story. If your doctors are really concerned about diffuse unpatterned alopecia (or DUPA - a rare form of AGA) then sure it could make sense to take it there as DUPA causes hair loss from the sides of the sclap But if none of your clinicians are really thinking about DUPA, then no, that is not a typical location.

I regret I can not offer more general information without obtaining a lot more information. If there is no thinning (or at minimum no trichoscopic evidence of miniaturization) on the crown and no thinning at all in the mid scalp or temples, then a diagnosis of AGA becomes increasingly unlikely. Not impossible, but statistically unlikely.

Biopsies of the sides of the scalp are still helpful sometimes to exclude other diseases (like scarring alopecia, diffuse alopecia areata, psoriatic alopecia, etc) but are rarely a great place to confirm AGA.

If AGA is really on the list and someone feels a biopsy is necessary, it is preferable that it be done somewhere in the area marked in black color below (for males). Temples are a bit more unreliable.