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Surgical management of the pyogenic granuloma or benign fibroadenoma is by means of an excision. An electrocauterizing unit is used to perform the excision. A skin graft or reconstruction of the nail bed are needed occasionally. Glomus tumors are excised by punching out or standard surgical excision with proximal nail avulsion.
Surgical excision of the subungual exostoses is performed under aseptic conditions and digital block. A partial nail avulsion is carried out and followed by a longitudinal incision in the nail bed. The tumor is carefully separated from the underlying nail bed, and it is removed with a fine chisel.
Surgical management of basal cell carcinoma, squamous cell carcinoma, and melanoma in established cases involves excision of the tumor with clear margins if bone metastasis is absent; Small basal cell carcinoma can be managed with the conservative excision. Most patients with the advanced skin cancers will be referred to the specialists for further evaluation and treatment. The treatments include Mohs micrographic surgery with a closure of skin graft, and the patient is closely monitored for recurrence. If bone metastasis has occurred, the extremity is amputated at the DIP joint or more proximally. Subungual melanoma can be managed by metacarpal or metatarsal ray amputation. Dissection of the regional nodes may be required.
