Técnicas para toma de biopsias ungulares
Palabras clave:
enfermedades de la uña, biopsia, técnicas.Resumen
La biopsia de uña constituye una herramienta invaluable para el diagnóstico de diversas enfermedades que afectan la unidad ungular; sin embargo, es infrecuente su práctica por el desconocimiento de las técnicas, la falta de experiencia de los especialistas o el miedo a las secuelas. El éxito de este procedimiento depende de la identificación precisa del área ungular de donde se debe tomar la biopsia, de la selección apropiada del tipo de biopsia para cada caso, del dominio de la técnica quirúrgica para obtener muestras representativas y aptas para estudio, y de una cautelosa remisión al dermatopatólogo quien procesará y estudiará con detenimiento el espécimen. El fracaso de este procedimiento puede significar resultados catastróficos para los pacientes. Objetivo. Ilustrar la forma adecuada de tomar una biopsia ungular. En la práctica diaria, observamos que no se realiza apropiadamente, lo que retrasa el diagnóstico de condiciones tan críticas como el melanoma.
Biografía del autor/a
Alvaro Acosta
Coordinador Dermatología, Instituto Nacional de Cancerología, Profesor Asociado Universidad Nacional de Colombia
Marian Rolón
Dermatóloga, Patóloga Oncóloga, Instituto Nacional de Cancerología, Fundación Santa Fe de Bogotá.
Catalina Muñoz
Fellow Cirugía Plástica Oncológica, Universidad Militar - Instituto Nacional de Cancerología.
Referencias bibliográficas
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2. Rich P. Nail biopsy: Indications and methods. Dermatol Surg. 2001;27:229-34.
3. Kovich O, Soldano A. Clinical pathologic correlations for diagnosis and treatment of nail disorders. Dermatologic Therapy. 2007;20:11-6.
4. Grover C, Nanda S, Reddy BS, Chaturvedi KU. Nail biopsy: Assessment of indications and outcome. Dermatol Surg. 2005;31:190-4.
5. Tosti A, Piraccini B. Biology of nails and nail disorders. En: Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, Wolff K. Fitzpatrick´s dermatology in general medicine. 8th edition. New York: McGraw Hill; 2012. p. 1009-30.
6. Grover C, Chaturvedi UK, Reddy BS. Role of nail biopsy as a diagnostic tool. Indian J Dermatol Veneorol Leprol. 2007;78:290-8.
7. Zook E. Preoperative and postoperative management. En: Krull E, Zook E, Baran R, Haneke E. Nail surgery: A text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 29-33.
8. Wong K, Huq N, Nakhooda A. Hand surgery using local anesthesia. Clin Plast Surg. 2013;40:567-81.
9. Williams J, Lalonde D. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plast Reconstr Surg. 2006;118:1195-200.
10. Harbinson S. Transthecal digital block: Flexor tendon sheath used for anesthetic infusion. J Hand Surg. 1991;16A:957.
11. Low C, Vartany A, Engstrom J, Poncelet A, Diao E. Comparison of transthecal and subcutaneous single-injection digital block techniques. J Hand Surg. 1997;22A:901-5.
12. Cummings A, Tisol W, Meyer L. Modified transthecal digital block versus traditional digital block for anesthesia of the finger. J Hand Surg Am. 2004;29:44-52.
13. Keramidas E, Rodopoulou A, Tsoutsos D, Miller G, Iovannovich J. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconst Surg. 2004;114:1131-4.
14. Kollersbeck C, Walcher T, Gradi G, Genelein F. Clinical experience and dosage pattern in subcutaneous single-injection digital block technique. Handchir Mikrochir Plast Chir. 2004;36:64-6.
15. Chowdhry S, Seidenstricker L, Cooney D, Hazany R, Wilhelmi B. Do not use epinephrine in digital blocks: Myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126:2031-4.
16. Fisher L, Gordon M. Anesthesia for hand surgery. En: Wolfe S, Hotchkiss R, Pederson W, Kozin S. Operative hand surgery. 6th edition. Philadelphia: Elsevier, Churchill Livingstone; 2011. p. 32-3.
17. Jellinek N. Nail surgery: Practical tips and treatment options. Dermatol Ther. 2007;20:68-74.
18. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose epinephrine: Does it cause finger necrosis and should it be treated? Hand. 2007;2:5-11.
19. Lalonde D, Bell M, Benoit P, Sparkles G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie Project clinical phase. J Hand Surg. 2005;30A:1061-7.
20. Wilhelmi B, Blackwell S, Miller J, Mancoli J, Dardano T, Tran A, et al. Do not use epinephrine in digital blocks: Myth or truth? Plast Reconstr Surg. 2001;107:393-400.
21. Huang C. Regional anesthesia. En: Harahap M, Abadir A. Anesthesia and analgesia in dermatologic surgery. New York: CRC Press; 2008. p. 102-3.
22. Montes A, Gómez L, Londoño A, Arias Y, Martínez E. Evaluación de una técnica quirúrgica para el tratamiento de la onicocriptosis en pacientes atendidos en la Clínica Universitaria Bolivariana y Clínica Soma, de enero de 1998 a diciembre de 2010. Rev Asoc Colomb Dermatol. 2012;20:322-9.
23. Haneke E. Nail surgery. Clin Dermatol. 2013;31:516-525
24. Di Chiacchio, Ruben B, Refkalevsky W. Longitudinal melanonychias. Clin Dermatol. 2013;31:594-601
25. Barrera M, Tejera A, Mendiola M, Cabra J, Herrera E. Diagnostic utility of nail biopsy: A study of 15 cases. Actas Dermosifiliogr. 2008;99:621-7.
26. Baran R, Berker D, Dawber R. Nail unit tumours and surgery. En: Baran R, Berker D, Dawber R.¿Editores? Manual of nail disease and surgery: New Jersey:Blackwell Science Ltd.; 1997. p. 53-88. Incompleto
27. Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, et al. Diagnosis and management of nail pigmentations. J Am Acad Dermatol. 2007;56:835-47.
28. Berker D. Lateral longitudinal nail biopsy. Australas J Dermatol. 2001;42:142-4.
29. Jellinek N. Nail matrix biopsy of longitudinal melanonychia: Diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol. 2007;56:803-10.
30. Di Chiacchio N, Refkalefsky L, Schwery N, Veiga F. Tangential biopsy thickness versus depth in longitudinal melanonychia: A pilot study. Dermat Res Pract. 2012:353864.
31. Geisse JK. Biopsy techniques for pigmented lesions of the skin. Pathology (Phila). 1994;2(2):181-93.
32. Collins S, Cordova K, Jellinek N. Alternatives to complete nail plate avulsion. J Am Acad Dermat. 2008;59:619-26.
33. Krull E. Biopsy techniques. En: Krull E, Zook E, Baran R, Haneke E. Nail surgery: A text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 55-81.
34. Martínez W, Restrepo R. Procesamiento de biopsias de piel en el laboratorio de patología. Rev Asoc Col Dermatol. 2014;22:39-55.
35. Campbell S, Rubin A. Update: Nail unit dermatopathology. Dermatol Ther. 2012;25:551-68.
36. Acosta A, Fierro E, Velásquez V, Rueda X. Melanoma: patogénesis, clínica e histopatología. Rev Asoc Col Dermatol. 2009;17:87-108.
37. Collins S, Cordova K, Jellinek N, Midline/paramedian longitudinal matrix excision with flap reconstruction: Alternative surgical techniques for evaluation of longitudinal melanonychia. J Am Acad Dermatol. 2010;62:627-36.
38. Silverstein D, Mariwall K. Biopsy of the pigmented lesions. Dermatol Clin. 2012;30:435-43.
39. Pozzobon F, Acosta A, Carreño A, Fierro E. Características del melanoma cutáneo primario en el Instituto Nacional de Cancerología, 2006-2010. Rev Asoc Col Dermatol. 2013;17:111-9.
40. Drake L, Dinehart S, Farmer E, Goltz R, Graham G, Hordinsky M, et al. Guidelines of care for superficial mycotic infections of the skin: Onychomycosis. J Am Acad Dermat. 1996;34:116-21.
41. Weinberg J, Koestenblatt E, Tutrone W, Tshler H, Najarian l. Comparison of diagnostic methods in the evaluation of onychomycosis. J Am Acad Dermatol. 2003;49:193-200.
42. Panasiti V, Borroni R, Devirgiliis V, Rossi M, Fabrizzio L, Masciangelo R, et al. Comparison of diagnostic methods in the diagnosis of dermatomycosis and onychomycoses. Mycoses. 2006;49:26-35.
43. Pierard G, Arrese J, De Doncker D, Franchimonto C. Present and potential diagnosis techniques in onychomycosis. J Am Acad Dermatol. 1996;34:273-80.
44. Gianni C, Morelli V, Cerri A, Greco C, Rossini P, Guiducci A, et al. Usefulness of histological examination for the diagnosis of onychomycosis. Dermatology. 2001;202:283-92.
45. Gómez L, Massaro M, Tabares A, Zuluaga A, Vélez J, Vélez A, et al. Utilidad de la muestra de la lámina ungular en el diagnóstico de onicomicosis. Rev Asoc Colomb Dermatol. 2011;19:194-200.
46. Haghani I, Shokohi T, Hajheidari Z, Khalilian A, Aghili S. Comparison of diagnostic methods in the evaluation of onychomycosis. Mycopathologia. 2013;175:315-21.
47. Grammar-West N, Corvette D, Giandonis M, Fitzpatrick J. Clinical pearl: Nail plate biopsy for the diagnosis of psoriatic nails. J Am Acad Dermatol. 1998;38:260-2.
48. Berker D, Baran R. Acquired malalignment: A complication of lateral longitudinal nail biopsy. Acta Derm Venereol. 1998;78:468-70.
2. Rich P. Nail biopsy: Indications and methods. Dermatol Surg. 2001;27:229-34.
3. Kovich O, Soldano A. Clinical pathologic correlations for diagnosis and treatment of nail disorders. Dermatologic Therapy. 2007;20:11-6.
4. Grover C, Nanda S, Reddy BS, Chaturvedi KU. Nail biopsy: Assessment of indications and outcome. Dermatol Surg. 2005;31:190-4.
5. Tosti A, Piraccini B. Biology of nails and nail disorders. En: Goldsmith L, Katz S, Gilchrest B, Paller A, Leffell D, Wolff K. Fitzpatrick´s dermatology in general medicine. 8th edition. New York: McGraw Hill; 2012. p. 1009-30.
6. Grover C, Chaturvedi UK, Reddy BS. Role of nail biopsy as a diagnostic tool. Indian J Dermatol Veneorol Leprol. 2007;78:290-8.
7. Zook E. Preoperative and postoperative management. En: Krull E, Zook E, Baran R, Haneke E. Nail surgery: A text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 29-33.
8. Wong K, Huq N, Nakhooda A. Hand surgery using local anesthesia. Clin Plast Surg. 2013;40:567-81.
9. Williams J, Lalonde D. Randomized comparison of the single-injection volar subcutaneous block and the two-injection dorsal block for digital anesthesia. Plast Reconstr Surg. 2006;118:1195-200.
10. Harbinson S. Transthecal digital block: Flexor tendon sheath used for anesthetic infusion. J Hand Surg. 1991;16A:957.
11. Low C, Vartany A, Engstrom J, Poncelet A, Diao E. Comparison of transthecal and subcutaneous single-injection digital block techniques. J Hand Surg. 1997;22A:901-5.
12. Cummings A, Tisol W, Meyer L. Modified transthecal digital block versus traditional digital block for anesthesia of the finger. J Hand Surg Am. 2004;29:44-52.
13. Keramidas E, Rodopoulou A, Tsoutsos D, Miller G, Iovannovich J. Comparison of transthecal digital block and traditional digital block for anesthesia of the finger. Plast Reconst Surg. 2004;114:1131-4.
14. Kollersbeck C, Walcher T, Gradi G, Genelein F. Clinical experience and dosage pattern in subcutaneous single-injection digital block technique. Handchir Mikrochir Plast Chir. 2004;36:64-6.
15. Chowdhry S, Seidenstricker L, Cooney D, Hazany R, Wilhelmi B. Do not use epinephrine in digital blocks: Myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126:2031-4.
16. Fisher L, Gordon M. Anesthesia for hand surgery. En: Wolfe S, Hotchkiss R, Pederson W, Kozin S. Operative hand surgery. 6th edition. Philadelphia: Elsevier, Churchill Livingstone; 2011. p. 32-3.
17. Jellinek N. Nail surgery: Practical tips and treatment options. Dermatol Ther. 2007;20:68-74.
18. Fitzcharles-Bowe C, Denkler K, Lalonde D. Finger injection with high-dose epinephrine: Does it cause finger necrosis and should it be treated? Hand. 2007;2:5-11.
19. Lalonde D, Bell M, Benoit P, Sparkles G, Denkler K, Chang P. A multicenter prospective study of 3,110 consecutive cases of elective epinephrine use in the fingers and hand: The Dalhousie Project clinical phase. J Hand Surg. 2005;30A:1061-7.
20. Wilhelmi B, Blackwell S, Miller J, Mancoli J, Dardano T, Tran A, et al. Do not use epinephrine in digital blocks: Myth or truth? Plast Reconstr Surg. 2001;107:393-400.
21. Huang C. Regional anesthesia. En: Harahap M, Abadir A. Anesthesia and analgesia in dermatologic surgery. New York: CRC Press; 2008. p. 102-3.
22. Montes A, Gómez L, Londoño A, Arias Y, Martínez E. Evaluación de una técnica quirúrgica para el tratamiento de la onicocriptosis en pacientes atendidos en la Clínica Universitaria Bolivariana y Clínica Soma, de enero de 1998 a diciembre de 2010. Rev Asoc Colomb Dermatol. 2012;20:322-9.
23. Haneke E. Nail surgery. Clin Dermatol. 2013;31:516-525
24. Di Chiacchio, Ruben B, Refkalevsky W. Longitudinal melanonychias. Clin Dermatol. 2013;31:594-601
25. Barrera M, Tejera A, Mendiola M, Cabra J, Herrera E. Diagnostic utility of nail biopsy: A study of 15 cases. Actas Dermosifiliogr. 2008;99:621-7.
26. Baran R, Berker D, Dawber R. Nail unit tumours and surgery. En: Baran R, Berker D, Dawber R.¿Editores? Manual of nail disease and surgery: New Jersey:Blackwell Science Ltd.; 1997. p. 53-88. Incompleto
27. Braun RP, Baran R, Le Gal FA, Dalle S, Ronger S, Pandolfi R, et al. Diagnosis and management of nail pigmentations. J Am Acad Dermatol. 2007;56:835-47.
28. Berker D. Lateral longitudinal nail biopsy. Australas J Dermatol. 2001;42:142-4.
29. Jellinek N. Nail matrix biopsy of longitudinal melanonychia: Diagnostic algorithm including the matrix shave biopsy. J Am Acad Dermatol. 2007;56:803-10.
30. Di Chiacchio N, Refkalefsky L, Schwery N, Veiga F. Tangential biopsy thickness versus depth in longitudinal melanonychia: A pilot study. Dermat Res Pract. 2012:353864.
31. Geisse JK. Biopsy techniques for pigmented lesions of the skin. Pathology (Phila). 1994;2(2):181-93.
32. Collins S, Cordova K, Jellinek N. Alternatives to complete nail plate avulsion. J Am Acad Dermat. 2008;59:619-26.
33. Krull E. Biopsy techniques. En: Krull E, Zook E, Baran R, Haneke E. Nail surgery: A text and atlas. Philadelphia: Lippincott Williams & Wilkins; 2001. p. 55-81.
34. Martínez W, Restrepo R. Procesamiento de biopsias de piel en el laboratorio de patología. Rev Asoc Col Dermatol. 2014;22:39-55.
35. Campbell S, Rubin A. Update: Nail unit dermatopathology. Dermatol Ther. 2012;25:551-68.
36. Acosta A, Fierro E, Velásquez V, Rueda X. Melanoma: patogénesis, clínica e histopatología. Rev Asoc Col Dermatol. 2009;17:87-108.
37. Collins S, Cordova K, Jellinek N, Midline/paramedian longitudinal matrix excision with flap reconstruction: Alternative surgical techniques for evaluation of longitudinal melanonychia. J Am Acad Dermatol. 2010;62:627-36.
38. Silverstein D, Mariwall K. Biopsy of the pigmented lesions. Dermatol Clin. 2012;30:435-43.
39. Pozzobon F, Acosta A, Carreño A, Fierro E. Características del melanoma cutáneo primario en el Instituto Nacional de Cancerología, 2006-2010. Rev Asoc Col Dermatol. 2013;17:111-9.
40. Drake L, Dinehart S, Farmer E, Goltz R, Graham G, Hordinsky M, et al. Guidelines of care for superficial mycotic infections of the skin: Onychomycosis. J Am Acad Dermat. 1996;34:116-21.
41. Weinberg J, Koestenblatt E, Tutrone W, Tshler H, Najarian l. Comparison of diagnostic methods in the evaluation of onychomycosis. J Am Acad Dermatol. 2003;49:193-200.
42. Panasiti V, Borroni R, Devirgiliis V, Rossi M, Fabrizzio L, Masciangelo R, et al. Comparison of diagnostic methods in the diagnosis of dermatomycosis and onychomycoses. Mycoses. 2006;49:26-35.
43. Pierard G, Arrese J, De Doncker D, Franchimonto C. Present and potential diagnosis techniques in onychomycosis. J Am Acad Dermatol. 1996;34:273-80.
44. Gianni C, Morelli V, Cerri A, Greco C, Rossini P, Guiducci A, et al. Usefulness of histological examination for the diagnosis of onychomycosis. Dermatology. 2001;202:283-92.
45. Gómez L, Massaro M, Tabares A, Zuluaga A, Vélez J, Vélez A, et al. Utilidad de la muestra de la lámina ungular en el diagnóstico de onicomicosis. Rev Asoc Colomb Dermatol. 2011;19:194-200.
46. Haghani I, Shokohi T, Hajheidari Z, Khalilian A, Aghili S. Comparison of diagnostic methods in the evaluation of onychomycosis. Mycopathologia. 2013;175:315-21.
47. Grammar-West N, Corvette D, Giandonis M, Fitzpatrick J. Clinical pearl: Nail plate biopsy for the diagnosis of psoriatic nails. J Am Acad Dermatol. 1998;38:260-2.
48. Berker D, Baran R. Acquired malalignment: A complication of lateral longitudinal nail biopsy. Acta Derm Venereol. 1998;78:468-70.
Cómo citar
1.
Acosta A, Rolón M, Muñoz C. Técnicas para toma de biopsias ungulares. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 9 de agosto de 2019 [citado 18 de abril de 2024];23(1):49-60. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/1066
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2019-08-09
Cómo citar
1.
Acosta A, Rolón M, Muñoz C. Técnicas para toma de biopsias ungulares. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 9 de agosto de 2019 [citado 18 de abril de 2024];23(1):49-60. Disponible en: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/1066
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