Nail Biopsy Protocol Guidelines

Pre-Procedure Preparation

The Centers for Disease Control and Prevention recommends performing hand hygiene with antimicrobial soap and water or alcohol-based hand rub before donning gloves 2
The Centers for Disease Control and Prevention suggests wearing medical gloves when potential exists for contacting blood or body fluids 2
The Centers for Disease Control and Prevention advises wearing a new pair of medical gloves for each patient and washing hands immediately after glove removal 2
The Centers for Disease Control and Prevention recommends wearing surgical mask and eye protection with solid side shields during procedures likely to generate splashing of blood or body fluids 3
The Centers for Disease Control and Prevention suggests donning protective clothing (gown, laboratory coat, or uniform) that covers personal clothing and skin likely to be soiled 3

The National Comprehensive Cancer Network recommends administering local anesthesia using periprostatic injection technique or topical anesthetic, as these methods have been shown to be safe and efficacious in reducing discomfort during biopsy procedures 4
The National Comprehensive Cancer Network suggests considering intravenous sedation or general anesthetic for exceptional cases such as patients with contraindications to local anesthesia 4

The American Academy of Dermatology recommends removing the nail plate sufficiently to expose the underlying lesion 1, 5
The American Academy of Dermatology suggests sampling the nail matrix adequately, as melanoma arises in this location 1, 5
The American Academy of Dermatology recommends performing excisional biopsy when feasible, encompassing the entire lesion 1
The American Academy of Dermatology suggests using incisional biopsy for larger lesions, ensuring adequate sampling of the nail matrix 1
The American Academy of Dermatology advises that only practitioners skilled in biopsy of the nail apparatus should perform these procedures 1, 5

The American Academy of Dermatology recommends preferring topical hemostatic agents such as aluminum chloride or ferric subsulfate solution over electrocautery 5
The American Academy of Dermatology suggests adding topical coagulants (absorbable gelatin) as needed 5
The American Academy of Dermatology advises using spot electrocautery only when necessary to control postprocedural bleeding 5

The American Academy of Dermatology recommends documenting the site, size, presence of ulceration, bleeding, or nodular features 1
The American Academy of Dermatology suggests photographing the lesion before biopsy 1
The American Academy of Dermatology advises noting macroscopic satellites around the clinical lesion, as these upstage melanoma to stage III 5
The American Academy of Dermatology recommends including Breslow thickness measurement in pathology reports 1
The American Academy of Dermatology suggests including presence or absence of ulceration in pathology reports 1
The American Academy of Dermatology advises including margins of excision status in pathology reports 1
The American Academy of Dermatology recommends including Clark level in pathology reports 1

The National Comprehensive Cancer Network recommends using appropriate anesthesia techniques to minimize discomfort 4
The Centers for Disease Control and Prevention advises removing gloves that are torn, cut, or punctured as soon as feasible and washing hands before regloving 3
The Centers for Disease Control and Prevention suggests keeping fingernails short with smooth, filed edges to allow thorough cleaning and prevent glove tears 2
The Centers for Disease Control and Prevention recommends changing protective clothing immediately if penetrated by blood or other potentially infectious fluids 3

The American Academy of Dermatology recommends never performing superficial sampling that may underestimate Breslow thickness in suspected melanoma 5
The American Academy of Dermatology advises not proceeding without adequate nail plate removal when the underlying lesion needs to be visualized 1, 5
The Centers for Disease Control and Prevention recommends not using artificial fingernails or extenders when performing procedures with direct patient contact 2