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CO2 laser-assisted nail matrix biopsy: a modified window-technique.

Giuseppe Emilio Cannata1, Andrea Sechi2

  • 1IRCCS Ospedale San Raffaele, Milan, Italy.

Lasers in Medical Science
|November 6, 2025
PubMed
Summary

A new CO₂ laser biopsy technique offers a minimally invasive way to diagnose longitudinal melanonychia (LM). This method aids in distinguishing benign conditions from melanoma while preserving nail structure and reducing complications.

Keywords:
CO₂ laserDermatologic surgeryHistopathological diagnosisLaser-assisted biopsyLongitudinal melanonychiaMatrix neviMelanocytic activationNail matrix biopsyNail punch biopsy window techniqueNail surgery

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Area of Science:

  • Dermatology
  • Oncology
  • Laser Surgery

Background:

  • Histopathological examination of the nail matrix is crucial for diagnosing longitudinal melanonychia (LM).
  • Traditional biopsy methods for LM can be invasive, complex, and risk permanent nail dystrophy.
  • There is a need for less invasive diagnostic techniques for LM.

Purpose of the Study:

  • To evaluate the feasibility, diagnostic accuracy, and cosmetic outcomes of a minimally invasive CO₂ laser-assisted biopsy for LM.
  • To compare the CO₂ laser-assisted biopsy with conventional methods for LM diagnosis.

Main Methods:

  • A retrospective case series of patients with single-digit LM undergoing CO₂ laser-assisted nail matrix biopsy.
  • A CO₂ laser created a window in the nail plate for a punch biopsy of the distal nail matrix.
  • Excised nail plate was repositioned as a dressing; patients were followed for healing and cosmetic outcomes.

Main Results:

  • Biopsy samples were sufficient for diagnosis in all 10 patients, identifying melanocytic activation (50%) and matrix nevi (40%).
  • Mild postoperative nail changes occurred in 50% of cases, particularly with fingernails and reinterventions; no severe nail dystrophy was observed.
  • Three patients required reintervention due to insufficient samples or recurrence.

Conclusions:

  • CO₂ laser-assisted biopsy is a minimally invasive and effective technique for diagnosing LM.
  • This method preserves nail structure and reduces complications compared to traditional biopsies.
  • Larger studies are needed to confirm long-term benefits over conventional techniques.