Nail Biopsy–Why, When, Where, How?

Abstract

The technique and significance o f nail biopsies with regard to mycotic and bacterial infections, onychopathy asso ciated with cutaneous and systemic diseases, and benign and malignant ungual neoplasms is discussed.

Dermoscopic Examination of Nail Pigmentation

“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14] Several clinical criteria have been proposed to help clinicians more accurately distinguish suggestive cases, 15 but neither a single clinical criterion nor a combination of symptoms currently can be used to avoid numerous useless painful nail matrix biopsies that may leave dystrophic scars. [16][17][18][19] Longitudinal melanonychia is suggestive when it is unique, polychrome, increasing in width, or accompanied by the Hutchinson sign (pigmentation of the cuticle). Also suggestive are onset during adulthood, absence of history of pigmentation-inducing treatment, and ethnic origin not usually associated with nail pigmentation.…”

“…35 Thisprocedureisusuallypainfulandoftenfollowed by the creation of definitive nail dystrophy due to the surgical injury to the nail matrix. [16][17][18][19] Different opinions have been expressed about the management of longitudinal melanonychia. [36][37][38] Some authors recommend systematic biopsy 39 ; others propose histopathologic diagnosis in suggestive cases only.…”

Basal cell carcinoma of the nail unit

“…24 BCC may mimic chronic paronychia, pyogenic granuloma, squamous cell carcinoma, amelanotic melanoma, trauma, dermatophyte infection, bacterial infection, and eczema. 4,7,8,12,14,20 Baran et al 25 has described one appropriate biopsy technique. Given the differential diagnosis, adequate biopsy may be accomplished with a shave biopsy, although invasive amelanotic melanoma and primary inflammatory disorders are better biopsied with full thickness techniques.…”

Surgical Gems: Biopsy of the Matrix of a Nail

“…I t is often necessary to take a biopsy from a nail in order to arrive at a correct diagnosis of disease and thus to be better able to institute appropriate treatment ,. Several techniques of biopsy of nails have been described previously, but a simple method to biopsy the matrix of a nail without the complication of a permanently distorted nail has been lacking .…”