Nail surgery is performed to remove benign and malignant nail tumors, alleviate pain secondary to ingrown and traumatized nails, and diagnose clinically ambiguous lesions and dystrophies. Because of the propensity for scarring and inadequate sampling, nail surgery is best performed by clinicians with appropriate training and experience. Prerequisites for a successful nail biopsy include a thorough understanding of nail anatomy, adequate anesthesia and hemostasis, and proper patient selection and preparation. Nail avulsions, biopsies, and excisions can be safely performed in the office setting