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nail melanoma – false negative?

Forums Cutaneous Melanoma Community nail melanoma – false negative?

  • Post
    Kevcurry
    Participant
    Hi everyone, recently I went to a podiatrist and he performed a 4mm punch biopsy on the second toe of my left foot to diagnose nail melanoma (had a black line in the middle and feint brownish bands that cover the black line for about 2 years). I really thought he knows what he was doing and I was hoping that he used a nail spatula to reflect the nail fold and collect the tissue sample (pigmented lesion) from the now exposed nail matrix but after I got home and looked at the toe, he actually did the punch biopsy on/over the proximal nail fold after nail avulsion. He also confirmed that with me. The pathology report says the tissue sample was: skin (4mm x 3mm x 2mm) and the diagnosis was :benign acral melanosis.” Since it was only 2mm thick, I’m not sure if the punch tool was able to collect tissues from nail matrix (where subungal melanoma originates). I read from this website, https://www.mdedge.com/dermatology/article/150656/dermatologic-surgery/nail-biopsies-made-simple and is says, ““Do not use a punch biopsy on the nail fold to diagnose melanoma – you will get a false negative,” Dr. Skelsey said.” I really don’t know if the podiatrist got the tissue sample from the the nail matrix or not. It seems this doctor wasn’t qualified for nail matrix biopsy? I called him and he said “since you have doubts, best thing to do is get another biopsy.” It has been about a month since the biopsy and he wants another biopsy. I don’t think the nail matrix is fully healed. I wonder if the pigmented lesion in the nail matrix is still there? I don’t have health insurance and I already paid him and the pathologist a lot of money for perhaps, a botched biopsy :( Maybe, the pathologist was looking at the tissues from the nail fold hence, it was a false negative? So worried right now. If I want a second opinion, how long do I have to wait before I can have another biopsy? Thanks for any input. I’d really appreciate it.

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  • Replies
      tedtell1
      Participant
      Kev;
      Noticed no one has replied to you. Hopefully someone will. I think it might be because there isn’t a huge amount of experience here on Melanoma and the nails. I have seen it mentioned, but not a lot of info. Continue to advocate for yourself! While another nail biopsy might be really nasty, it sounds like it might be the way to go. Is your podiatrist experienced with melanoma of the nail. I think in this circumstance it might be beneficial to find a specialist who is knowledgeable in the area to get it right!
      Good luck and God Bless,
      Ted

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      lkb
      Participant
      Would it make sense to have a melanoma specialist read the report/confer with with podiatrist?

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