PART A – Dermatological findings after alleged torture 13 II. MICROSCOPIC CHANGES If a victim agrees, a 3-4 mm punch biopsy, under local anaesthesia, might be helpful in supporting an allegation of electrical torture (Danielsen et al., 1978; Danielsen et al., 1978, Thomsen et al., 1983; Karlsmark et al., 1984, Karlsmark et al., 1988; Danielsen et al., 2003; Thomsen, 1984; Karlsmark, 1990). Previously, only few cases of electrical torture have been studied histologically (Danielsen et al., 1991; Öztop, Lök, Baykal & Tunca, 1994; Danielsen, Karlsmark & Thomsen, 1997; TATGroup against Torture, 2001). Only in one case, in which lesions were excised seven days after the injury, were alterations in the skin diagnostic of electrical injuries observed (deposition of calcium salts on dermal fibres in viable tissue located around necrotic tissue at the surface and on collagen fibres deep in the dermis). Lesions excised a few days after the alleged electric torture showed segmental changes and deposits of calcium salts on cellular structures, consistent with the influence of an electric current, but with only a moderate degree of support. A biopsy taken one month after the alleged electrical torture showed a conical scar, 1-2 mm broad, with an increased number of fibroblasts and tightly packed, thin collagen fibres arranged in parallel to the surface, consistent with electrical injury, but with only a slight degree of support. A biopsy taken five days after alleged electrical torture via the use of a battery-driven electrical instrument, probably delivering high-frequency alternating current, where the concomitant heat development dominates, showed non-specific alterations with subepidermal bullae consistent with thermal injuries. ≠≠ Toxic contact dermatitis could be a differential diagnosis, the support to the history of torture being of a slight degree. Even if an examination does not reveal any abnormal findings, the possible use of electrical torture cannot be excluded. The use of high-frequency ultrasound may be helpful in discovering the location of calcium deposits in order to select an area for biopsy (Danielsen, 2002) (For more information refer to chapter V, sections C.1, D.1 and D.5 of the Istanbul Protocol).