In order to properly diagnose and treat a nail that is less than pretty, we always first perform a nail biopsy. This involves trimming a portion of nail, the underlying skin and any debris that may come along with this. This is typically painless and has a great benefit for us. Nail biopsies help us to identify the true cause of the altered appearance of the nail. Fungus is not always the culprit. Rather, it can be due to a previous injury, pressure on the nail that is chronic, systemic disease such as psoriasis, use of certain medications, or even skin cancer. The pathologists evaluate the nail specimen itself but they also run a course of stains on the sample to assess for fungus or melanin pigments that can indicate a bigger problem.

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