Nail is a unique appendage in the human body. From a medical point of view, nails undergo changes with age as well as in response to dermatologic and systemic diseases. The response of nails to various diseases is limited, thus causing diagnostic dilemmas. Many nail disorders are not amenable to medical treatment. Early surgical treatment can save a phalanx as well as life. Nail matrix manipulation can lead to permanent nail dystrophy. A proper knowledge of nail unit anatomy and training to do nail unit surgeries can help in accurate diagnosis, as well as treatment of many nail unit disorders on out patient basis.