The punch biopsy [5, 6] is the primary technique to obtain full-thickness specimens and is suitable for inflammatory lesions especially those with deep components such as lupus erythematosus and vasculitis. A disposable punch biopsy instrument is used which consists of a circular blade attached to a pencillike handle. The diameter varies from 2 to 8 mm, but in most cases a 3–4 mm instrument is adequate. The selected biopsy site is cleaned with a skin antiseptic such as isopropyl alcohol or povidone-iodide. A surgical marker can be used to mark the intended biopsy site. A local anesthetic, usually 1 % or 2 % lidocaine with epinephrine, is administered adjacent to or into the lesion by raising a skin wheal to decrease discomfort and bleeding. Epinephrine should be avoided for distal acral lesions. The skin surrounding the biopsy site is stretched perpendicular to the lines of least skin tension to obtain an oval-shaped wound. The punch is placed perpendicular to the skin and rotated downward using a twirling motion with constant pressure. Once the instrument reaches the subcutaneous fat and resistance lessens, the instrument is removed. The specimen is gently elevated with forceps or a needle tip, and scissors are used to free it from the subcutaneous tissue by cutting below the dermis or if possible below the subcutaneous tissue when fat needs to be sampled. Care is required in removing the specimen to prevent crushing artifacts. The specimen should be immediately placed in fixative (10 % formalin) or Michel’s medium for immunofluorescence. The wound can be closed with one or two nylon sutures. Small wounds can be allowed to heal by secondary intention. On the scalp, best results are achieved by holding the instrument along the axis of the hair follicle. When different fixatives are required, two specimens should be taken rather than cutting one specimen into two parts. Care must be taken on the areas where the skin is thin or overlying the bone to decrease the possibility of hitting the periosteum or the nerves and arteries below the skin. Post procedure, Vaseline or antibiotic ointment can be applied, followed by a dry dressing.