M any dermatoses can affect the subcutaneous tissue. The clinical presentation is polymorphous as in cutaneous polyarteritis nodosa, exhibiting the spectra of inflamed nodules, deep ulcers, digital infarcts, livedo reticularis, and stellate scars. Consequently, a reliable, clinically guided, histologic examination is crucial in achieving an accurate diagnosis. Unfortunately, clinicopathologic incongruity is not uncommonly encountered–the fault occasionally lies in sampling of inadequate tissue. To circumvent this problem, incisional wedge biopsies have been considered as the gold standard for the evaluation of these disorders.1 The potential disadvantage of incisional biopsies, however, is the time consumption of using this technique on multiple locations. Sampling of tissue with intense, perilesional fibrosis and necrosis such as an ulcer makes hemostasis and closure of an elliptic defect nearly impossible. Another limitation of the incisional biopsy is that the sample is taken along a single axis. For example, a biopsy of an ulcer aligned in the 12 o’clock to 6 o’clock axis would, therefore, not be able to include histologically relevant tissue at the 3 o’clock edge. To address these issues, we describe a technique called the “double-trephine punch.” Although the trephine punch tool used in hair transplants has been previously proposed for the diagnosis of panniculitis, the tool is not readily available in a dermatology clinic,2 and subcutaneous tissue would also be difficult to recover from such a small and deep defect (Fig 1). Our proposed technique can be regarded as a compound punch biopsy using common, disposable, cutaneous punch tools. Sampling may occur at various locations along the margins and within the center of the lesion. Such a procedure is quickly and easily performed and would not require a second office visit for more involved biopsies. The tools necessary to perform the double-trephine punch are simply that which are used in a standard punch-biopsy procedure. An additional 8-mm punch tool is necessary, and the optional availability of electrocautery and Gelfoam (Pharmacia & Upjohn Company, Kalamazoo, Mich). The site for sampling is chosen to ensure the highest yield. Observing standard, clean, surgical procedure techniques, the lesion is prepared and locally anesthetized. Countertraction is applied with the nondominant hand, and the 8-mm punch tool is inserted to the hilt of the instrument to obtain the initial sample (Fig 2, left). Once the superficial core is removed, subcutaneous tissue should be readily