Nail biopsy: Indications and techniques
- Phoebe Rich, MD
Phoebe Rich, MD
- Clinical Associate Professor of Dermatology
- Oregon Health Science University
- Julie A Jefferson, MD
Julie A Jefferson, MD
- Dermatology Resident
- Johns Hopkins University
A nail biopsy is performed to diagnose clinically ambiguous nail lesions or dystrophies or to remove tumors . Because of the propensity for scarring and inadequate sampling, nail biopsies are best performed by clinicians with appropriate training and experience. Prerequisites for a successful nail biopsy include a thorough understanding of nail anatomy, adequate anesthesia and hemostasis, and proper patient selection and preparation .
Before performing a nail biopsy, it is important to discuss with the patient the potential benefits and risks of the procedure and address the patient’s concerns about pain or scarring.
This topic will discuss nail biopsy techniques according to anatomic site (eg, nail bed, nail fold, nail matrix). The anatomy of the nail, anesthesia and hemostasis techniques, patient selection, preoperative preparation, and postoperative care are discussed separately. (See "Principles and overview of nail surgery".)
The choice of the biopsy technique is usually based upon the site of the pathology within the nail and the risk of permanent scarring associated with the technique .
The nail plate needs to be partially or completely avulsed to allow access to the primary biopsy site regardless of biopsy technique . Partial nail plate avulsion is sufficient in many cases and avoids unnecessary trauma to the adjacent, uninvolved tissue (picture 1) . However, complete nail plate avulsion is occasionally necessary to achieve maximum exposure of the nail bed and matrix. (See "Nail avulsion and chemical matricectomy", section on 'Nail avulsion'.)
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- PREOPERATIVE PREPARATION
- NAIL BED BIOPSY
- - Punch biopsy
- Double punch technique
- - Elliptical excision
- NAIL FOLD BIOPSY
- NAIL MATRIX BIOPSY
- General principles
- Full thickness techniques
- - Punch biopsy
- - Longitudinal elliptical excision
- - Lateral longitudinal excision
- - Transverse matrix excision
- Partial thickness techniques
- - Tangential (shave) excision