Mohs micrographic surgery (MMS) is commonly performed for malignant nail tumors, achieving high cure rates while sparing uninvolved skin1'2 using meticulous histologic analysis of the entire cut surgical margin.3 When frozen section MMS is unavailable, more-traditional surgery with frozen (bread-loaf) histologic sections may be performed, or modified (slow) MMS with rush paraffin sections.4 Traditionally, total or partial nail plate avulsions precede all such surgeries (except en bloc excision). One of us has advocated said use of avulsion for several reasons.2 Cutting the nail tissues through the plate is more difficult than without it, and plate removal facilitates gross examination of the nail bed, matrix, and lateral sulci and is a logical preceding step to debulking and curettage of the tumor. Ideally, such avulsions are performed with minimal trauma to the thin epithelium of the nail bed so that subsequent histology demonstrates all representative epithelium for analysis.
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