Think small: a smarter approach to formalin use in dermatology clinics and offices

Abstract

Prefilled formalin containers are essential in dermatology for preserving biopsy specimens. However, formalin is a toxic and carcinogenic chemical requiring careful handling and requires proper disposal. Reducing its use without compromising specimen integrity can offer both environmental and financial benefits. We analyzed all skin biopsies performed from January 1 to December 31, 2024, across Penn State Dermatology clinics (N = 11,284). We conducted a theoretical cost and waste assessment comparing three commonly available prefilled formalin container sizes: 20 mL with 10 mL fill (20/10 mL), 40/20 mL, and 60/30 mL. Using institutional pricing and biopsy volumes, we projected cost and formalin waste over 1, 5, and 10 years. The 20/10 mL container had the lowest annual cost at $5,303.48, compared to $6,996.08 and $6,883.24 for the 40/20 mL and 60/30 mL containers, respectively. Currently, the 60/30 mL container is standard across clinics. Transitioning to the 20/10 mL option would reduce formalin waste by 2,256.8 L over 10 years and save approximately $17,000. In addition, new clinic racks designed to secure smaller containers reduce tipping and potential spills, enhancing safety. Switching to smaller formalin containers for skin biopsies is a simple, effective intervention to cut costs, reduce toxic waste, and improve safety in dermatology practice. Further gains could be realized through the adoption of formalin recycling systems. This initiative underscores the importance of sustainable practices in dermatologic care and serves as a model for environmentally conscious clinical decision-making, while also improving safety.