U032. Biopsies in Challenging Locations: a Review for the General Dermatologist

The presentation focuses on the intricacies of performing nail biopsies, particularly in challenging locations, guided by Molly Hinshaw. She discusses the coding for nail procedures, emphasizing the limited reimbursement which doesn't reflect the effort involved. Hinshaw advocates for effective training and practice in nail biopsies, suggesting that dermatologists become comfortable with the technique to better serve their patients. She shares pearls of wisdom on avoiding complications, such as not punching through the proximal nail fold, and highlights the importance of performing a partial avulsion when needed. Key techniques include using 3mm punch biopsies in the nail bed for optimal healing and avoiding specific areas to prevent scarring. Hinshaw also emphasizes the significance of proper patient communication regarding procedures and post-operative care. She instructs on taking comprehensive pre-operative photos for tracking and diagnostic purposes and shares various techniques for anesthesia and minimizing patient discomfort during the procedure. The discussion touches upon the indications for nail biopsies, including onychodystrophy, erythronychia, and longitudinal melanonychia, with practical examples. Finally, she highlights the need for meticulous methods in biopsy procedures to ensure cosmetic and functional outcomes, demonstrating the importance of ongoing education and skill development in dermatologic surgery.