Performing punch biopsies of the scalp can be very difficult due to increased blood supply in that area. Injecting saline into the biopsy site after injecting lidocaine and prior to taking punch biopsy can help make this easier. — Maria Bips, PA-C, Asheville, N.C. (189-5)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.