Skip to main content
SpringerLink
Log in
Book cover

Evidence-Based Procedural Dermatology pp 571–584Cite as

Nail Procedures

  • Chapter
  • First Online:

  • 1372 Accesses

Abstract

The evidence-based treatment of nail disease remains a challenge. Unlike in the skin, the nails are slow growing and many interventions will not be readily apparent for several months. Many practitioners do not feel comfortable with invasive nail procedures and, relative to the remaining skin, nail biopsies are done by fewer practitioners. Indeed, most residents perform less than ten nail procedures in their training, and 30% of residents do not feel competent in nail diseases at the conclusion of their residency (4) (Clark et al. Dermatol Surg 42:696–698, 2016). Experts have noted significant knowledge gaps among practitioners for nail procedures (5) (Hare and Rich, Dermatol Clin 34:269–73, 2016). Especially in the procedural realm, high-level evidence in the form of randomized trials and prospective cohorts is rarely available. Oftentimes, case reports, case series, and expert opinion dictate the standard of care for nail procedures.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD   199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Clark MA, Yoo SS, Kundu RV. Nail surgery techniques: a single center survey study on the effect of a cadaveric hand practicum in dermatology resident education. Dermatol Surg. 2016;42(5):696–8.

    Article  CAS  PubMed  Google Scholar 

  2. Hare AQ, Rich P. Clinical and educational gaps in diagnosis of nail disorders. Dermatol Clin. 2016;34(3):269–73.

    Article  CAS  PubMed  Google Scholar 

  3. Haneke E. Nail surgery. Clin Dermatol. 2013;31(5):516–25.

    Article  PubMed  Google Scholar 

  4. Ronger S, et al. Dermoscopic examination of nail pigmentation. Arch Dermatol. 2002;138(10):1327–33.

    Article  PubMed  Google Scholar 

  5. Braun RP, et al. Surgical pearl: dermoscopy of the free edge of the nail to determine the level of nail plate pigmentation and the location of its probable origin in the proximal or distal nail matrix. J Am Acad Dermatol. 2006;55(3):512–3.

    Article  PubMed  Google Scholar 

  6. Richert B, Caucanas M, Andre J. Diagnosis using nail matrix. Dermatol Clin. 2015;33(2):243–55.

    Article  CAS  PubMed  Google Scholar 

  7. McGinness JL, Parlette HL 3rd. Versatile sterile field for nail surgery using a sterile glove. Dermatol Online J. 2005;11(3):10.

    Article  PubMed  Google Scholar 

  8. Abimelec P. Tips and tricks in nail surgery. Semin Cutan Med Surg. 2009;28(1):55–60.

    Article  CAS  PubMed  Google Scholar 

  9. Park KK, Sharon VR. A review of local anesthetics: minimizing risk and side effects in cutaneous surgery. Dermatol Surg. 2016;43(2):173–87.

    Article  CAS  Google Scholar 

  10. Keramidas EG, Rodopoulou SG. Ropivacaine versus lidocaine in digital nerve blocks: a prospective study. Plast Reconstr Surg. 2007;119(7):2148–52.

    Article  CAS  PubMed  Google Scholar 

  11. Schnabl SM, et al. Skin perfusion and pain evaluation with different local anaesthetics in a double blind randomized study following digital nerve block anaesthesia. Clin Hemorheol Microcirc. 2013;55(2):241–53.

    Article  CAS  PubMed  Google Scholar 

  12. Vinycomb TI, Sahhar LJ. Comparison of local anesthetics for digital nerve blocks: a systematic review. J Hand Surg Am. 2014;39(4):744–51. e5.

    Article  PubMed  Google Scholar 

  13. Jellinek NJ, Velez NF. Nail surgery: best way to obtain effective anesthesia. Dermatol Clin. 2015;33(2):265–71.

    Article  CAS  PubMed  Google Scholar 

  14. Dixit S, et al. Ice anaesthesia in procedural dermatology. Australas J Dermatol. 2013;54(4):273–6.

    Article  PubMed  Google Scholar 

  15. Palmon SC, Lloyd AT, Kirsch JR. The effect of needle gauge and lidocaine pH on pain during intradermal injection. Anesth Analg. 1998;86(2):379–81.

    Article  CAS  PubMed  Google Scholar 

  16. Hogan ME, et al. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86–98. e1.

    Article  PubMed  Google Scholar 

  17. Jellinek NJ. Commentary: how much is too much? Tourniquets and digital ischemia. Dermatol Surg. 2013;39(4):593–5.

    Article  CAS  PubMed  Google Scholar 

  18. Middleton SD, et al. Variability in local pressures under digital tourniquets. J Hand Surg Eur Vol. 2014;39(6):637–41.

    Article  CAS  PubMed  Google Scholar 

  19. Wapler C, et al. A prospective study of 100 cases of sterile T-RING digital tourniquet application. Hand Surg Rehabil. 2016;35(4):271–9.

    Article  CAS  PubMed  Google Scholar 

  20. Denkler K. A comprehensive review of epinephrine in the finger: to do or not to do. Plast Reconstr Surg. 2001;108(1):114–24.

    Article  CAS  PubMed  Google Scholar 

  21. Lalonde D, et al. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: the Dalhousie Project clinical phase. J Hand Surg Am. 2005;30(5):1061–7.

    Article  PubMed  Google Scholar 

  22. Ilicki J. Safety of epinephrine in digital nerve blocks: a literature review. J Emerg Med. 2015;49(5):799–809.

    Article  PubMed  Google Scholar 

  23. Chowdhry S, et al. Do not use epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(6):2031–4.

    Article  CAS  PubMed  Google Scholar 

  24. de Berker DA, et al. Retronychia: proximal ingrowing of the nail plate. J Am Acad Dermatol. 2008;58(6):978–83.

    Article  PubMed  Google Scholar 

  25. Collins SC, Cordova K, Jellinek NJ. Alternatives to complete nail plate avulsion. J Am Acad Dermatol. 2008;59(4):619–26.

    Article  PubMed  Google Scholar 

  26. Jellinek NJ, Cordova KB. Frozen sections for nail surgery: avulsion is unnecessary. Dermatol Surg. 2013;39(2):312–4.

    Article  CAS  PubMed  Google Scholar 

  27. Jellinek NJ, Velez NF, Knackstedt TJ. Recovery after matrix shave biopsy. Dermatol Surg. 2016;42(10):1227–9.

    Article  CAS  PubMed  Google Scholar 

  28. Weinand C, et al. A comparison of complications in 400 patients after native nail versus silicone nail splints for fingernail splinting after injuries. World J Surg. 2014;38(10):2574–9.

    Article  PubMed  Google Scholar 

  29. Kain N, Koshy O. Evacuation of subungual haematomas using punch biopsy. J Plast Reconstr Aesthet Surg. 2010;63(11):1932–3.

    Article  PubMed  Google Scholar 

  30. Khan MA, West E, Tyler M. Two millimetre biopsy punch: a painless and practical instrument for evacuation of subungual haematomas in adults and children. J Hand Surg Eur Vol. 2011;36(7):615–7.

    Article  PubMed  Google Scholar 

  31. Kim JE, et al. Proximal nail fold-lunula double punch technique: a less invasive method for sampling nail matrix without nail avulsion. Indian J Dermatol Venereol Leprol. 2011;77(3):346–8.

    Article  PubMed  Google Scholar 

  32. Siegle RJ, Swanson NA. Nail surgery: a review. J Dermatol Surg Oncol. 1982;8(8):659–66.

    Article  CAS  PubMed  Google Scholar 

  33. Haneke E, Baran R. Longitudinal melanonychia. Dermatol Surg. 2001;27(6):580–4.

    Article  CAS  PubMed  Google Scholar 

  34. Richert B, et al. Tangential excision of pigmented nail matrix lesions responsible for longitudinal melanonychia: evaluation of the technique on a series of 30 patients. J Am Acad Dermatol. 2013;69(1):96–104.

    Article  PubMed  Google Scholar 

  35. Metzger S, et al. Extent and consequences of physician delay in the diagnosis of acral melanoma. Melanoma Res. 1998;8(2):181–6.

    Article  CAS  PubMed  Google Scholar 

  36. Benati E, et al. Clinical and dermoscopic clues to differentiate pigmented nail bands: an International Dermoscopy Society study. J Eur Acad Dermatol Venereol. 2017;31(4):732–6.

    Article  PubMed  Google Scholar 

  37. Jellinek N. Nail matrix biopsy of longitudinal melanonychia: diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol. 2007;56(5):803–10.

    Article  PubMed  Google Scholar 

  38. Di Chiacchio N, et al. Tangential biopsy thickness versus lesion depth in longitudinal melanonychia: a pilot study. Dermatol Res Pract. 2012;2012:353864.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yaemsiri S, et al. Growth rate of human fingernails and toenails in healthy American young adults. J Eur Acad Dermatol Venereol. 2010;24(4):420–3.

    Article  CAS  PubMed  Google Scholar 

  40. Lai WY, et al. Clinical characteristics and treatment outcomes of patients undergoing nail avulsion surgery for dystrophic nails. Hong Kong Med J. 2011;17(2):127–31.

    CAS  PubMed  Google Scholar 

  41. Hanno R, Mathes BM, Krull EA. Longitudinal nail biopsy in evaluation of acquired nail dystrophies. J Am Acad Dermatol. 1986;14(5 Pt 1):803–9.

    Article  CAS  PubMed  Google Scholar 

  42. Grover C, et al. Longitudinal nail biopsy: utility in 20-nail dystrophy. Dermatol Surg. 2003;29(11):1125–9.

    PubMed  Google Scholar 

  43. de Berker DA. Lateral longitudinal nail biopsy. Australas J Dermatol. 2001;42(2):142–4.

    Article  PubMed  Google Scholar 

  44. Jellinek NJ, Rubin AI. Lateral longitudinal excision of the nail unit. Dermatol Surg. 2011;37(12):1781–5.

    Article  CAS  PubMed  Google Scholar 

  45. Collins SC, Cordova KB, Jellinek NJ. Midline/paramedian longitudinal matrix excision with flap reconstruction: alternative surgical techniques for evaluation of longitudinal melanonychia. J Am Acad Dermatol. 2010;62(4):627–36.

    Article  PubMed  Google Scholar 

  46. Jellinek NJ. Flaps in nail surgery. Dermatol Ther. 2012;25(6):535–44.

    Article  PubMed  Google Scholar 

  47. Zaiac MN, Weiss E. Mohs micrographic surgery of the nail unit and squamous cell carcinoma. Dermatol Surg. 2001;27(3):246–51.

    CAS  PubMed  Google Scholar 

  48. Dika E, et al. Mohs surgery for squamous cell carcinoma of the nail unit: 10 years of experience. Dermatol Surg. 2015;41(9):1015–9.

    Article  CAS  PubMed  Google Scholar 

  49. Tang N, et al. A retrospective study of nail squamous cell carcinoma at 2 institutions. Dermatol Surg. 2016;42(Suppl 1):S8–s17.

    Article  CAS  PubMed  Google Scholar 

  50. Dika E, et al. Two synchronous periungual BCC treated with Mohs surgery. Nail polish related? Cutan Ocul Toxicol. 2013;32(2):161–3.

    Article  PubMed  Google Scholar 

  51. Brasie RA, Patel AR, Nouri K. Basal cell carcinoma of the nail unit treated with Mohs micrographic surgery: superficial multicentric BCC with jagged borders – a histopathological hallmark for nail unit BCC. J Drugs Dermatol. 2006;5(7):660–3.

    PubMed  Google Scholar 

  52. Martinelli PT, et al. Periungual basal cell carcinoma: case report and literature review. Dermatol Surg. 2006;32(2):320–3.

    CAS  PubMed  Google Scholar 

  53. Etzkorn JR, et al. Low recurrence rates for in situ and invasive melanomas using Mohs micrographic surgery with melanoma antigen recognized by T cells 1 (MART-1) immunostaining: tissue processing methodology to optimize pathologic staging and margin assessment. J Am Acad Dermatol. 2015;72(5):840–50.

    Article  CAS  PubMed  Google Scholar 

  54. Bricca GM, Brodland DG, Zitelli JA. Immunostaining melanoma frozen sections: the 1-hour protocol. Dermatol Surg. 2004;30(3):403–8.

    PubMed  Google Scholar 

  55. High WA, et al. Presentation, histopathologic findings, and clinical outcomes in 7 cases of melanoma in situ of the nail unit. Arch Dermatol. 2004;140(9):1102–6.

    Article  PubMed  Google Scholar 

  56. Brodland DG. The treatment of nail apparatus melanoma with Mohs micrographic surgery. Dermatol Surg. 2001;27(3):269–73.

    CAS  PubMed  Google Scholar 

  57. Terushkin V, et al. Digit-sparing Mohs surgery for melanoma. Dermatol Surg. 2016;42(1):83–93.

    Article  CAS  PubMed  Google Scholar 

  58. Jellinek NJ, Bauer JH. En bloc excision of the nail. Dermatol Surg. 2010;36(9):1445–50.

    Article  CAS  PubMed  Google Scholar 

  59. Moehrle M, et al. “Functional” surgery in subungual melanoma. Dermatol Surg. 2003;29(4):366–74.

    PubMed  Google Scholar 

  60. Heaton KM, et al. Surgical management and prognostic factors in patients with subungual melanoma. Ann Surg. 1994;219(2):197–204.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Nguyen JT, et al. Surgical management of subungual melanoma: mayo clinic experience of 124 cases. Ann Plast Surg. 2013;71(4):346–54.

    Article  CAS  PubMed  Google Scholar 

  62. Park KG, Blessing K, Kernohan NM. Surgical aspects of subungual malignant melanomas. The Scottish Melanoma Group. Ann Surg. 1992;216(6):692–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  63. Neczyporenko F, et al. Management of in situ melanoma of the nail apparatus with functional surgery: report of 11 cases and review of the literature. J Eur Acad Dermatol Venereol. 2014;28(5):550–7.

    Article  CAS  PubMed  Google Scholar 

  64. Nakamura Y, et al. Effects of non-amputative wide local excision on the local control and prognosis of in situ and invasive subungual melanoma. J Dermatol. 2015;42(9):861–6.

    Article  PubMed  Google Scholar 

  65. Duarte AF, et al. Nail melanoma in situ: clinical, dermoscopic, pathologic clues, and steps for minimally invasive treatment. Dermatol Surg. 2015;41(1):59–68.

    Article  CAS  PubMed  Google Scholar 

  66. Sureda N, et al. Conservative surgical management of subungual (matrix derived) melanoma: report of seven cases and literature review. Br J Dermatol. 2011;165(4):852–8.

    Article  CAS  PubMed  Google Scholar 

  67. Lazar A, Abimelec P, Dumontier C. Full thickness skin graft for nail unit reconstruction. J Hand Surg Br. 2005;30(2):194–8.

    Article  CAS  PubMed  Google Scholar 

  68. Furukawa H, et al. Melanoma of thumb: retrospective study for amputation levels, surgical margin and reconstruction. J Plast Reconstr Aesthet Surg. 2007;60(1):24–31.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Dermatology, Cleveland Clinic Foundation, Cleveland, OH, USA

    Daniel R. Knabel & Thomas J. Knackstedt

  2. Dermatology Professionals, Inc., East Greenwich, RI, USA

    Nathaniel J. Jellinek

  3. Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA

    Nathaniel J. Jellinek

  4. Division of Dermatology, University of Massachusetts Medical School, Worcester, MA, USA

    Nathaniel J. Jellinek

Authors
  1. Daniel R. Knabel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nathaniel J. Jellinek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Thomas J. Knackstedt
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Dermatology, Northwestern University, Chicago, IL, USA

    Murad Alam

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Knabel, D.R., Jellinek, N.J., Knackstedt, T.J. (2019). Nail Procedures. In: Alam, M. (eds) Evidence-Based Procedural Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-030-02023-1_35

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-02023-1_35

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-02022-4

  • Online ISBN: 978-3-030-02023-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation