Be an informed patient by avioding common mistakes and misperceptions about a visit for you first nail evaluation.
The Biopsy Appointment
THE STEPS OF A BIOPSY:
Prep: The doctor will administer anesthesia, and he may choose to soak the nail in water or a water and antiseptic mixture to soften the nail. It’s difficult to numb the fingers, so it’s likely the application of the anesthesia will hurt, but nothing beyond this step should cause pain. The doctor may apply a tourniquet to the finger to reduce bleeding.
Step 1: Release the cuticle. Working with a nail elevator, the doctor lifts the entire cuticle, separating it from the nail plate.
Step 2: Expose the nail. Two incisions are made in the proximal nail fold so the cuticle area can be folded back and the entire nail exposed.
Step 3: Release the nail. Using a nail elevator, the doctor releases the nail plate from the nail bed. Depending on what needs to be biopsied, the doctor will cut away half the plate or the whole plate. Note: in some situations, the distal half (closest to the free edge) of the nail is all that will need to be removed. In these cases, there is no reason to lift the cuticle or make incisions to the nail fold.
Step 4: Secure a sample. In cases where a biopsy of the nail bed is needed, the doctor will use one of three tools to secure a sample: a biopsy punch, a shaving blade, or a scalpel. The biopsy punch removes a round hole from the surface of the nail bed; the shaving blade will scrape the surface of the nail bed to gather a sample. The scalpel is used when a larger section of the nail bed and matrix is needed. A section from the back of the matrix to the middle of the nail bed is removed.
Step 5: Clean the area, stitching the incisions as necessary.
In all, the biopsy appointment takes about 45 minutes, and the patient may leave the office with a prescription for an antibiotic. It could take two to three weeks to hear the results of the biopsy.
KNOW BEFORE YOU GO:
You’re about to have a biopsy because there is a potentially serious problem developing under, on, or around your nail. The biopsy will take a section of your nail, or of the nail bed with matrix, or possibly both. You need to understand your nail may not grow back to its normal look; there could be permanent cosmetic change to the nail. This is emotional for many people, but it’s an unavoidable reality, because nails can scar easily.
Another thing to understand is that your nail will take up to six months to grow back and during that time you should avoid applying any type of enhancement to the nail.
Depending on the preference of the doctor, here are some tools you may see during a biopsy:
Clippers: a professional version of the common, household tool
Nippers: resembling cable cutters, nippers help a doctor grasp, hold, and cut at a particular angle
Dermatoscope: a polarized light used to stop the glare
Biopsy punch: similar to how a cookie cutter is used, the biopsy punch carves out perfect circle from the nail bed
Scraper: a blade used for scraping
Splitter: similar to nippers but used to cut through very thick nails
Elevator: with a flat, thin, extended end, the elevator is used to pry the nail plate away from the nail bed