Tangential/Shave Excision: Nail Surgery Procedures to Diagnose and Manage Common Nail Disorders

This presentation covers tangential and shave excision techniques used in nail surgery to diagnose and manage common nail disorders, particularly focusing on melanoma, erythronychia, and onychomatricoma. The speaker emphasizes the importance of these procedures in accurately diagnosing nail conditions, where tangential excision is particularly effective for epithelial processes. Historical references to the procedure's origins are provided, alongside a discussion of the ideal goals—diagnosis, reducing recurrence, and cost-efficiency. Diagnostic indications for tangential excision include melanin as a primary matrix issue, various forms of erythronychia without deep lesions, and onychomatricomas that can appear similarly to fungal infections. Techniques for non-invasive diagnostics using nail clippings are detailed, underscoring the significance of thorough biopsies to prevent misdiagnosis. The speaker highlights practical surgical tips for achieving effective results while maintaining minimal scarring. Each case illustrated emphasizes the need for careful consideration of specimen thickness and proper handling to ensure quality tissue samples for pathology. The discussion culminates with the evolving understanding of procedure techniques, stressing the necessity of adapting approaches based on tumor characteristics. Overall, tangential excision emerges as a pivotal procedure in nail surgery, allowing for precise diagnosis, treatment, and improved patient outcomes.