When is nail surgery recommended for melanonychia?

Melanonychia describes a brown or black band, streak, or area of pigment in the nail. It can have harmless explanations, including pigment variation, trauma, medicines, or changes around the nail. A dermatologist assesses the band, the surrounding skin, the number of nails involved, and how it has changed. Surgery is considered when the appearance cannot be safely explained by examination or when a sample from the nail unit is needed. The procedure may involve sampling the nail bed or matrix, where nail growth begins, rather than simply trimming the visible nail.

Arrange a dermatology assessment for a new, widening, irregular, or changing dark band. Photograph the nail in good light and note when you first noticed it. Do not cover the pigment with polish before the appointment, and do not attempt to scrape or drill the nail. Tell the clinician about injury, medications, pigment on other nails, and any personal or family history of skin cancer. Ask how a sample would be taken and how nail growth may look during healing.

Seek prompt assessment if pigment spreads onto the skin beside the nail, the band becomes broader or uneven, the nail splits, or a spot bleeds or does not heal. These signs do not identify the cause by themselves, but they should not be ignored. After sampling, contact the clinic for uncontrolled bleeding, increasing pain, pus, or spreading redness.

Ask what features are concerning, whether monitoring is appropriate, which nail-unit area would be sampled, how results will guide care, and what changes should lead to review.