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
- Micrographic Surgery and Dermatologic Oncology Fellow
- Department of Dermatology, University of British Columbia
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'.)
- Rich P. Nail biopsy: indications and methods. Dermatol Surg 2001; 27:229.
- Jellinek N. Nail matrix biopsy of longitudinal melanonychia: diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol 2007; 56:803.
- Collins SC, Cordova K, Jellinek NJ. Alternatives to complete nail plate avulsion. J Am Acad Dermatol 2008; 59:619.
- Jellinek NJ. Nail surgery: practical tips and treatment options. Dermatol Ther 2007; 20:68.
- Haneke E, Baran R. Longitudinal melanonychia. Dermatol Surg 2001; 27:580.
- Rich P, Scher RK. Nail signs and their definitions: non-specific nail dystrophies. In: An Atlas of Diseases of the Nail, Parthenon Publishing, New York 2003. p.13.
- Rich P. Nail Surgery. In: Dermatology, Bolognia JL, Jorizzo JL, Rapini RP (Eds), Mosby, New York 2006. p.2260.
- Moossavi M, Scher RK. Complications of nail surgery: a review of the literature. Dermatol Surg 2001; 27:225.
- De Berker D, Mawhinney B, Sviland L. Quantification of regional matrix nail production. Br J Dermatol 1996; 134:1083.
- Fleckman P. Chapter 3: Structure and function of the nail unit. In: Nails: Diagnosis, Therapy, and Surgery, Scher RK, Daniel CR III (Eds), Elsevier Saunders, China 2005. p.13.
- Haneke E. Chapter 1: Surgical anatomy of the nail apparatus. In: Nail Surgery, Richert B, Di Chiacchio N, Haneke E (Eds), Informa Healthcare, New York 2011. p.1.
- Haneke E. Operative Therapie akraler und subungualer Melanome. In: Operative und onkologische Dermatologie. Forschritte der operative und onkologischen Dermatologie 15, Rompel R, Petres J (Eds), Springer, Berlin 1999. p.210.
- Richert B, Theunis A, Norrenberg S, André J. Tangential excision of pigmented nail matrix lesions responsible for longitudinal melanonychia: evaluation of the technique on a series of 30 patients. J Am Acad Dermatol 2013; 69:96.
- 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