How do you approach nail surgery to diagnose NUBs (neoplasms of uncertain behavior)?  

I tend to opt for punch biopsy to diagnose nail tumors. A larger punch (i.e. 4-6mm) can be used to remove the nail plate. Then, a slightly smaller punch (i.e. 3-5mm) can be used to biopsy the tumor. If there is no concern for involvement or relevant pathology of the nail plate, it can be secured bac...

So many nail neoplasms originate at the matrix that I often perform a nail matrix biopsy without avulsing the nail to obtain a diagnosis.

A punch is a good way to make the diagnosis of possible tumors. Additional procedures may be necessary depending on the biopsy results.