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  • Presentation

Surgical Tips on Obtaining Optimal Nail Specimens for Nail Neoplastic and Inflammatory Disorders

Description

The presentation discusses surgical techniques for obtaining optimal nail specimens essential for diagnosing nail neoplastic and inflammatory disorders, emphasizing the importance of accurate biopsy methods to avoid misdiagnosis, particularly in cases like subungual melanoma. Various biopsy types are covered, such as nail clipping, punch biopsies, and elliptical excisions, with specific guidelines on their application and orientation to minimize nail dystrophy. The speaker advocates for techniques like tangential excision and recommends thorough visualization of the nail matrix for precise diagnoses. Methods for submitting specimens to dermatopathologists are also suggested to enhance diagnostic accuracy. The session addresses different conditions including onychomatricoma, onychocytic carcinoma, and inflammatory disorders like psoriasis and lichen planus, highlighting the significance of understanding nail anatomy in surgical practice. The presentation concludes by urging adherence to these techniques to achieve better patient outcomes and invites participation in future dermatological conferences.

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Conclusions

  • Nearly 30% of subungual melanomas are misdiagnosed due to inadequate biopsy techniques.
  • Accurate histopathological examination is crucial for diagnosing nail conditions.
  • Well-preserved and representative nail specimens are essential for dermatopathology.
  • Nail clipping is an effective, painless method for obtaining samples without causing nail dystrophy.
  • Punch and elliptical excision techniques are important for optimal biopsy samples from the nail unit.
  • The lateral longitudinal biopsy allows for comprehensive analysis of the nail anatomy.
  • Tangential nail biopsy minimizes the risk of nail dystrophy while permitting total lesion removal.
  • Partial or total nail avulsion can provide better visualization for accurate biopsies in suspected melanoma cases.
  • Dermatologists should employ gentle techniques in specimen collection to ensure better outcomes.
  • Understanding the nail unit anatomy is vital for obtaining optimal samples for histopathological evaluation.
  • Stephen F, Tosti A, Rubin Al. Diagnostic Applications of Nail Clippings. Dermatol Clin 33 (2015) 289-301
  • Krull EA. Biopsy Techniques. In: Krull ED, Zook EG, Baran R, Haneke E. Nail Surgery - a text and atlas, 1 ed: Philadelphia. Lippincott Williams & Wilkins. 2001;55-81.
  • Jin A, Haynes D, Rodriguez O, Park JH, Jellinek N, Rubin AI. A Review of the Histopathology of Nail Unit Tumors Including Selection of the Optimal Surgical Sampling. Skin Appendage Disord. 2024 Dec;10(6):443-458.
  • Zaiac MN, Ocampo-Garza J. Modified Tangential Excision of the Nail Matrix. J Am Acad Dermatol. 2018 Aug 3.
  • Ocampo-Garza J, Dominguez-Cherit J et al. Submitting tangential nail-matrix specimens. J Am Acad Dermatol. 2017 Nov;77(5):e133-e134.
  • Bertanha L, Michalany AO, Damas II, Di Chiacchio N, Cintra ML. Tangential biopsy of the nail bed and matrix, with plate evaluation, for diagnosis of lichen planus. J Eur Acad Dermatol Venereol. 2024 Sep 20.