Why is a nail biopsy done?
A biopsy of the nail is done to help diagnose nail disorders.
It involves taking a small piece of tissue from various components of the nail,
so that we can recommend an appropriate treatment plan.
What conditions can we diagnose from a nail biopsy?
- Fungal nail infections
- Causes of darkening or pigmentation
of the nail
- Causes of nail deformities
- Tumours, which may be benign or
- Other inflammatory disorders, such
as lichen planus or psoriasis
Figure 1: Diagram of a nail
How is a nail biopsy done?
Local anaesthesia is given through an injection to the
finger or toe. The exact nature of the procedure depends on the part of the nail involved.
Nail avulsion –
This involves removing a part of or the entire nail plate.
Nail bed biopsy – This is usually done to diagnose a tumour in the nail bed. The
nail is lifted up and the underlying tissue will be removed.
Nail matrix biopsy – This is usually done to diagnose a tumour in the nail matrix,
such as when the nail is deformed or darkened. The nail and proximal nail fold
are lifted to collect the underlying tissue. Stitches may be required to secure
the nailfold back in place after the procedure. The nail may also be stitched
back in place, allowing it to act as a natural dressing during wound healing.
Matricectomy (with carbon dioxide laser)
This is usually done for persistent or recurrent ingrown
nails, to remove the portion of the nail that causes discomfort. The nail is
lifted from under the edge of the skin and a portion of the nail is removed.
The proximal nail fold is lifted up and carbon dioxide laser
treatment is done to the nail matrix (where the nail is made) to prevent the
ingrown nail from recurring.
How can I prepare for nail surgery?
Please remove any traces of nail varnish from the nails.
Shower on the day of the procedure before coming down to the centre. If there
are no specific instructions from your doctor, have your breakfast and
medication as usual. Defer any travel plans for 2 weeks after the procedure.
You should not drive a car on the day of the surgery. For toenail surgery, do remember
to come down in sandals or slippers as a bandage will be applied after the
surgery to prevent bleeding.
What are the risks?
Your doctor will explain the potential risks for this type
of surgery with you in more detail, but complications include:
at the site of surgery
- Pain. The local anaesthetic should last until you return home. Aspirin free pain relief (such as paracetamol) should relieve any discomfort. The doctor or nurse caring for you can give you more advice.
- Nerve damage. Although your surgeon
will try to avoid this, nerves can occasionally be damaged during surgery, leading to a numb area of skin. This is usually temporary.
- Infection at the wound site. You will
be given instructions on how to care for your wound to minimise this risk.
- Scarring. You may have a scar after
the surgery. The doctors use closure techniques to minimise the appearance of this. Scars will improve over time.
- Permanent nail dystrophy: There can
be residual pigmentation of the nail plate and permanent nail abnormalities.
What should I expect after nail surgery? Wound healing usually takes 2 weeks. In more complicated
procedures, this will be longer. For fingernail surgery, you are advised to
avoid wet work and heavy lifting during this period. For toenail surgery, you
are advised to avoid prolonged standing, walking and vigorous exercise.
Post-procedural numbness especially over the tip of the finger/toe
may persist for up to 12 months.There may also be slight discomfort that can last for
Will I have a follow-up appointment?
You will have a follow-up appointment one to two weeks
after your surgery to check that your skin is healing well and to remove any
stitches that you may have. If there are any changes to this, you will be
advised on the day of your surgery.
Figure 2: Nail matrix biopsy