Cutaneous manifestations of rheumatic diseases are frequently observed and often present early in the course of rheumatic diseases, sometimes before the occurrence of systemic symptoms [1]. As such, close examination of the skin can help in early diagnosis and treatment of rheumatic disease as well as proper disease monitoring to prevent severe complications from systemic disease. Skin biopsies are a commonly performed procedure that provides valuable information to help establish the diagnosis of various rheumatic diseases, such as lupus erythematous, vasculitis, and dermatomyositis. While the skin biopsy is a powerful diagnostic aid in rheumatic diseases, understanding the timing, location, and type of biopsy is integral to optimizing a biopsy's yield in providing accurate pathologic results. This review aims to provide a comprehensive overview of indications for skin biopsies, different types of biopsies, and how to perform and interpret biopsies in patients with suspected or known rheumatic diseases.