HPI: The patient has had this problem for three years. She works out a lot and recalls trauma to the toe,
O/E: The left great toe nail is dystrophic, The nail is quite short and there is brownish green discoloration under the abnormal nail. There is some hemorrhage under the proximal nail fold.
Lab: KOH was positive for hyphae, but fungal culture is negative at 14 days.
Impression: Nail dystrophy in a 52 year-old woman. While this is probably traumatic, the long history is of concern and I feel that biopsy should be considered to rule out malignancy.
Questions: What is your diagnosis? Would you obtain a biopsy to rule out malignancy given the long history.