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Nail matrix biopsy

Author: Dr Cliff Rosendahl, Associate Professor, School of Medicine, The University of Queensland, Australia, 2013. Reviewed by Prof Luc Thomas, Lyon 1 University, France.

What is nail matrix biopsy?

Nail matrix biopsy is a surgical procedure in which a tissue specimen is obtained from the growth plate of a fingernail or toenail.

Why is nail matrix biopsy undertaken?

Nail matrix biopsy is undertaken to make or confirm a diagnosis or to surgically remove a skin lesion that is affecting the growth nail plate. The following list describes some conditions in which this procedure may be undertaken.

How is a nail biopsy done?

Nail biopsy is usually undertaken under local anaesthetic. This is injected locally or more often by digital block, when the anaesthetic is injected through the webspaces along each side of the finger or toe.

Various techniques are used to biopsy the nail matrix. The nail plate may be removed for examination, or replaced after the procedure. Here we provide a step by step guide to the “trap door” or “pop the bonnet” technique for biopsy of pigmented nail matrix lesions. This allows a direct view of the nail matrix permitting precise targeted biopsy of the lesion.

What are the risks of nail biopsy?

Nail biopsy can lead to any of the usual complications from a surgical procedure, such as bleeding, infection, scarring, incorrect diagnosis and incomplete removal of a tumour.

Scarring of the nail matrix is common and may result in permanent deformity of the nail plate. This is inevitable if the width of a full-thickness nail matrix biopsy is greater than 3 mm.

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